Provider Demographics
NPI:1669457909
Name:PANUSH, DANIEL E (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:E
Last Name:PANUSH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32255 NORTHWESTERN HWY
Mailing Address - Street 2:STE 130
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-1505
Mailing Address - Country:US
Mailing Address - Phone:248-354-9666
Mailing Address - Fax:248-354-3653
Practice Address - Street 1:28625 NORTHWESTERN HWY
Practice Address - Street 2:SUITE 213
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1828
Practice Address - Country:US
Practice Address - Phone:248-354-9666
Practice Address - Fax:248-354-3653
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301035149207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI102416OtherGREAT LAKES HEALTH PLAN
MI0636952OtherBCBS INDIVIDUAL
MI110169408OtherRR MEDICARE
MIB0281OtherM'CARE
MI1669457909Medicaid
MI700F314390OtherBLUE SHIELD
MI700F314390OtherBLUE SHIELD
MI0M96210020Medicare PIN