Healthcare Provider Details

I. General information

NPI: 1902801442
Provider Name (Legal Business Name): DANIEL O BILLMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 12/04/2020
Certification Date: 12/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1012 E 2ND ST
DULUTH MN
55805-2200
US

IV. Provider business mailing address

1012 E 2ND ST
DULUTH MN
55805-2200
US

V. Phone/Fax

Practice location:
  • Phone: 218-249-7870
  • Fax: 218-249-7801
Mailing address:
  • Phone: 218-249-7870
  • Fax: 218-249-7801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number38109
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number38109
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: