Provider Demographics
NPI:1710397120
Name:MICHAEL, DANIEL PAUL JR
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:PAUL
Last Name:MICHAEL
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9805 INGRAM ST
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-2868
Mailing Address - Country:US
Mailing Address - Phone:734-355-1448
Mailing Address - Fax:
Practice Address - Street 1:45001 FORD RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-2907
Practice Address - Country:US
Practice Address - Phone:734-844-2733
Practice Address - Fax:734-844-2765
Is Sole Proprietor?:No
Enumeration Date:2014-05-07
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53020263331835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy