MEDICARE: RONALD PHILIP DALTON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	4301071649	MI
2	208000000X	Pediatrics Physician	4301071649	MI
3	208000000X	Pediatrics Physician	036-173810	IL
4	208000000X	Pediatrics Physician	13202-320	WI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	700C61000	OTHER		BCBS, MEDICARE PLUS BLUE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RD071649	OTHER	MI	BCBS OF MI
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	34010000	OTHER	WI	EDS

General Provider Information

NPI Number	:	1407851413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONALD PHILIP DALTON MD

Provider Business Mailing Address
First Line	:	1400 W ICE LAKE RD
Second Line	:
City	:	IRON RIVER
State	:	MI
Zip	:	49935-9526
Country	:	US
Telephone Number	:	906-265-6121
Fax Number	:	906-265-4245

Provider Business Practice Location Address
First Line	:	1300 W ICE LAKE RD
Second Line	:
City	:	IRON RIVER
State	:	MI
Zip	:	49935-8507
Country	:	US
Telephone Number	:	906-265-8189
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	04/09/2025

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Directions to “ RONALD PHILIP DALTON MD” Practice Location

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