Provider Demographics
NPI:1982871265
Name:SMALLEY, DANIEL R (DO)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:R
Last Name:SMALLEY
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:2249 WEALTHY ST SE
Mailing Address - Street 2:STE 202
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-3052
Mailing Address - Country:US
Mailing Address - Phone:248-952-1601
Mailing Address - Fax:248-952-1614
Practice Address - Street 1:105 S WILDWOOD CROSSING 20
Practice Address - Street 2:
Practice Address - City:LUDINGTON
Practice Address - State:MI
Practice Address - Zip Code:49431-8719
Practice Address - Country:US
Practice Address - Phone:231-233-1704
Practice Address - Fax:231-780-6090
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-15
Last Update Date:2015-07-29
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Provider Licenses
StateLicense IDTaxonomies
MI5101009049207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIDS009049OtherSTATE LICENSE