Provider Demographics
NPI:1891734570
Name:ORRON, DAN EVIATHAR (MD)
Entity Type:Individual
Prefix:
First Name:DAN
Middle Name:EVIATHAR
Last Name:ORRON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2837 US 41 W
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-2252
Mailing Address - Country:US
Mailing Address - Phone:906-225-3964
Mailing Address - Fax:906-226-3875
Practice Address - Street 1:580 W COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-2705
Practice Address - Country:US
Practice Address - Phone:906-225-7808
Practice Address - Fax:906-225-7818
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME909632085R0204X
MI43010798442085R0204X
IL0361075172085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0E21024OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
FL02361984Medicaid
IL206147OtherMEDICARE PTAN (GROUP)
IL036107517Medicaid
IL206147080OtherMEDICARE PTAN (INDIVIDUAL)
DO4700Medicare PIN
DD3877Medicare ID - Type Unspecified
IL206147080OtherMEDICARE PTAN (INDIVIDUAL)
MIN48910011Medicare PIN
IL036107517Medicaid