Provider Demographics
NPI:1912987033
Name:DAUM, MICHAEL G (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:G
Last Name:DAUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:6715 W HIGHWAY 98
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32506-5923
Mailing Address - Country:US
Mailing Address - Phone:850-453-6737
Mailing Address - Fax:850-453-1196
Practice Address - Street 1:6715 W HIGHWAY 98
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32506-5923
Practice Address - Country:US
Practice Address - Phone:850-453-6737
Practice Address - Fax:850-453-1196
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2011-06-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME 55248207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL253831800Medicaid
AL59168748OtherBLUE CROSS BLUE SHIELD AL
FLA426OtherHELTH FIRST NETWORK
FL42927OtherBLUE CROSS BLUE SHIELD FL
FLP00200287OtherRAIL ROAD MEDICARE
AL59168748OtherBLUE CROSS BLUE SHIELD AL
FLA426OtherHELTH FIRST NETWORK