Healthcare Provider Details

I. General information

NPI: 1356378780
Provider Name (Legal Business Name): DANIEL MAAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 S 4TH ST
ISHPEMING MI
49849-2151
US

IV. Provider business mailing address

101 S 4TH ST
ISHPEMING MI
49849-2151
US

V. Phone/Fax

Practice location:
  • Phone: 906-486-4431
  • Fax: 906-485-2504
Mailing address:
  • Phone: 906-486-4431
  • Fax: 906-485-2504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6401004365
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: