Provider Demographics
NPI:1891778163
Name:ELIEFF, DANIEL KEVIN (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:KEVIN
Last Name:ELIEFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1510 24TH AVE N
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-1304
Mailing Address - Country:US
Mailing Address - Phone:320-259-0208
Mailing Address - Fax:320-259-0715
Practice Address - Street 1:1510 24TH AVE N
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-1304
Practice Address - Country:US
Practice Address - Phone:320-259-0208
Practice Address - Fax:320-259-0715
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN38413207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G09515Medicare UPIN