Healthcare Provider Details

I. General information

NPI: 1235067885
Provider Name (Legal Business Name): DANIEL JOSEPH MEDIA RN, BSN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42198 WILLSHARON ST
STERLING HEIGHTS MI
48314-3074
US

IV. Provider business mailing address

42198 WILLSHARON ST
STERLING HEIGHTS MI
48314-3074
US

V. Phone/Fax

Practice location:
  • Phone: 586-469-5214
  • Fax: 586-469-6636
Mailing address:
  • Phone: 586-469-5214
  • Fax: 586-469-6636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZF0201X
TaxonomyForensic Pathology Physician
License Number4704173412
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: