Provider Demographics
NPI:1265882401
Name:MAMMEL, DANIEL MARK (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:MARK
Last Name:MAMMEL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9325 UPLAND LN N STE 360
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-4463
Mailing Address - Country:US
Mailing Address - Phone:612-322-6903
Mailing Address - Fax:763-416-0158
Practice Address - Street 1:9875 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-4648
Practice Address - Country:US
Practice Address - Phone:612-322-6903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-19
Last Update Date:2023-07-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO20190229852080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine