Healthcare Provider Details

I. General information

NPI: 1083727200
Provider Name (Legal Business Name): DANIEL J MARGO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 10/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1542 GOLF COURSE RD
GRAND RAPIDS MN
55744-9603
US

IV. Provider business mailing address

520 NW 1ST AVE STE 5
GRAND RAPIDS MN
55744-2776
US

V. Phone/Fax

Practice location:
  • Phone: 218-327-7973
  • Fax: 218-327-3245
Mailing address:
  • Phone: 218-327-7973
  • Fax: 218-327-3245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number39379
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: