Provider Demographics
NPI:1821011651
Name:MIHALO, DANIEL STEPHEN (DO)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:STEPHEN
Last Name:MIHALO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1526 N DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-3562
Mailing Address - Country:US
Mailing Address - Phone:920-358-7526
Mailing Address - Fax:
Practice Address - Street 1:1526 N DIVISION ST
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-3562
Practice Address - Country:US
Practice Address - Phone:920-358-7526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101006909207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIB46188Medicare UPIN