Provider Demographics
NPI:1255353009
Name:MIDDLETON, DANIEL L (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:L
Last Name:MIDDLETON
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 1:602 BEECH ST
Mailing Address - Street 2:STE 1200
Mailing Address - City:CLARE
Mailing Address - State:MI
Mailing Address - Zip Code:48617-1466
Mailing Address - Country:US
Mailing Address - Phone:989-802-5080
Mailing Address - Fax:989-802-5090
Practice Address - Street 1:602 BEECH ST
Practice Address - Street 2:STE 1200
Practice Address - City:CLARE
Practice Address - State:MI
Practice Address - Zip Code:48617-1466
Practice Address - Country:US
Practice Address - Phone:989-802-5080
Practice Address - Fax:989-802-5090
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301048907207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1019741OtherMHP, HAN
MI4885082Medicaid
MI01003055OtherHEALTHPLUS
MI2971806Medicaid
MI4846128Medicaid
MI4947819Medicaid
MI7002946010OtherBDBSM BCN PLUS COM BLUE
MI01003055OtherBAY HEALTH PLAN
MICN5519 POO358808OtherMETRAHEALTH
MI1019741OtherMHP, HAN
MI0294601050Medicare ID - Type Unspecified
MI4846128Medicaid