Provider Demographics
NPI:1831127158
Name:CARREL, DANIEL (DO)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:CARREL
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:PO BOX 1500
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48376-1500
Mailing Address - Country:US
Mailing Address - Phone:248-324-0700
Mailing Address - Fax:248-324-1477
Practice Address - Street 1:1260 EKHART ST NE
Practice Address - Street 2:STE112
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-1380
Practice Address - Country:US
Practice Address - Phone:616-356-5202
Practice Address - Fax:616-458-9845
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101010006207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI700B510850OtherBCBS OF MI
MICD6543-P00297382OtherRR MEDICARE
MI4857060Medicaid
MI4857060Medicaid
MIM40150133Medicare ID - Type Unspecified