Provider Demographics
NPI:1922076777
Name:VERBURG, DANIEL J (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:J
Last Name:VERBURG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2390 MITCHELL PARK DR
Mailing Address - Street 2:UNIT D
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-8965
Mailing Address - Country:US
Mailing Address - Phone:231-487-9355
Mailing Address - Fax:231-487-1737
Practice Address - Street 1:2390 MITCHELL PARK DR
Practice Address - Street 2:UNIT D
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-8965
Practice Address - Country:US
Practice Address - Phone:231-487-9355
Practice Address - Fax:231-487-1737
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301035417207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1602410911OtherBCBS
MI4085801Medicaid
MI160B41011OtherBCBS MI
MI383445481OtherTAX ID
MI160046901OtherRR MEDICARE
MI0B41179OtherBCBS MI
MI383445481OtherTAX ID
MIMI1268Medicare PIN
MIMI1268001Medicare PIN
MI0B41179OtherBCBS MI
MI1602410911OtherBCBS