Healthcare Provider Details

I. General information

NPI: 1023504065
Provider Name (Legal Business Name): DANIEL CAICEDO PROANO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2018
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 LOWELL DR SE STE 101
HUNTSVILLE AL
35801-3755
US

IV. Provider business mailing address

930 FRANKLIN ST SE
HUNTSVILLE AL
35801-4312
US

V. Phone/Fax

Practice location:
  • Phone: 256-265-1310
  • Fax: 256-265-1311
Mailing address:
  • Phone: 256-801-6504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberMD.48965
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: