Provider Demographics
NPI:1841222080
Name:BIELAK, DANIEL (DO)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:BIELAK
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 1:5900 WALDON RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-4806
Mailing Address - Country:US
Mailing Address - Phone:248-625-1058
Mailing Address - Fax:248-625-3670
Practice Address - Street 1:5900 WALDON RD
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-4806
Practice Address - Country:US
Practice Address - Phone:248-625-1058
Practice Address - Fax:248-625-3670
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101006604207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIE25657Medicare UPIN
MIN83650002Medicare PIN