Provider Demographics
NPI:1912926791
Name:DONOVAN, DANIEL J (DO)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:J
Last Name:DONOVAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10101 S 27TH ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132-7209
Mailing Address - Country:US
Mailing Address - Phone:414-325-4950
Mailing Address - Fax:414-325-4951
Practice Address - Street 1:10101 S 27TH ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:WI
Practice Address - Zip Code:53132-7209
Practice Address - Country:US
Practice Address - Phone:414-325-4950
Practice Address - Fax:414-325-4951
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI23750207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30016600Medicaid
WI000080240Medicare ID - Type Unspecified
WI30016600Medicaid
WI034373840Medicare Oscar/Certification