Provider Demographics
NPI:1831189299
Name:WATSON, DANNY F (MD)
Entity type:Individual
Prefix:DR
First Name:DANNY
Middle Name:F
Last Name:WATSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:43097 WOODWARD AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BLOOMFIELD TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48302-5041
Mailing Address - Country:US
Mailing Address - Phone:248-253-9070
Mailing Address - Fax:248-253-9072
Practice Address - Street 1:43097 WOODWARD AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:BLOOMFIELD TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48302-5041
Practice Address - Country:US
Practice Address - Phone:248-253-9070
Practice Address - Fax:248-253-9072
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-26
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010553012084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2929277Medicaid
0F36413005Medicare ID - Type Unspecified
D76385Medicare UPIN