Provider Demographics
NPI:1295749323
Name:MCDONNELL, DANIEL E (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:E
Last Name:MCDONNELL
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 1:560 W MITCHELL ST
Mailing Address - Street 2:SUITE 505
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-2275
Mailing Address - Country:US
Mailing Address - Phone:231-487-2100
Mailing Address - Fax:231-487-6049
Practice Address - Street 1:560 W MITCHELL ST
Practice Address - Street 2:SUITE 505
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-2275
Practice Address - Country:US
Practice Address - Phone:231-487-2100
Practice Address - Fax:231-487-6049
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301035087207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104092708Medicaid
MI2902457961OtherBCBSM PIN
MIDM035087OtherBS STATE LIC#
MIB48272Medicare UPIN
MIDM035087OtherBS STATE LIC#