Provider Demographics
NPI:1871847590
Name:DANIEL, MICHAEL KEITH (PA)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:KEITH
Last Name:DANIEL
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 BATTERY LN
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37220-1051
Mailing Address - Country:US
Mailing Address - Phone:901-482-1951
Mailing Address - Fax:
Practice Address - Street 1:820 GALE LN
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37204-3012
Practice Address - Country:US
Practice Address - Phone:615-298-5406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-02
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2255363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant