Healthcare Provider Details

I. General information

NPI: 1407851413
Provider Name (Legal Business Name): RONALD PHILIP DALTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 W ICE LAKE RD
IRON RIVER MI
49935-8507
US

IV. Provider business mailing address

1400 W ICE LAKE RD
IRON RIVER MI
49935-9526
US

V. Phone/Fax

Practice location:
  • Phone: 906-265-8189
  • Fax:
Mailing address:
  • Phone: 906-265-6121
  • Fax: 906-265-4245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301071649
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301071649
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036-173810
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number13202-320
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: