Provider Demographics
NPI:1255445441
Name:OCKNER, DANIEL MATTHEW (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:MATTHEW
Last Name:OCKNER
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 1:22151 MOROSS ROAD
Mailing Address - Street 2:SJHMC-DEPARTMENT OF PATHOLOGY
Mailing Address - City:GROSSE POINTE WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48236
Mailing Address - Country:US
Mailing Address - Phone:313-343-3520
Mailing Address - Fax:313-881-4727
Practice Address - Street 1:22151 MOROSS ROAD
Practice Address - Street 2:SJHMC-DEPARTMENT OF PATHOLOGY
Practice Address - City:GROSSE POINTE WOODS
Practice Address - State:MI
Practice Address - Zip Code:48236
Practice Address - Country:US
Practice Address - Phone:313-343-3520
Practice Address - Fax:313-881-4727
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI073095207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4667421Medicaid
N94390011Medicare ID - Type Unspecified
MI4667421Medicaid