Provider Demographics
NPI:1770667362
Name:DANIEL L MIDDLETON MD PC
Entity Type:Organization
Organization Name:DANIEL L MIDDLETON MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:MIDDLETON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-839-9925
Mailing Address - Street 1:7101 W WACKERLY ST
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48642
Mailing Address - Country:US
Mailing Address - Phone:989-839-9925
Mailing Address - Fax:989-631-0886
Practice Address - Street 1:7101 W WACKERLY ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48642
Practice Address - Country:US
Practice Address - Phone:989-839-9925
Practice Address - Fax:989-631-0886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301048907207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2971806Medicaid
F04695Medicare UPIN
N84010001Medicare ID - Type Unspecified