Healthcare Provider Details

I. General information

NPI: 1891896239
Provider Name (Legal Business Name): DANIEL LEE COURNEYA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 07/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 E 25TH ST
HIBBING MN
55746-3897
US

IV. Provider business mailing address

PO BOX 366
HIBBING MN
55746-0366
US

V. Phone/Fax

Practice location:
  • Phone: 218-312-3005
  • Fax: 218-312-3003
Mailing address:
  • Phone: 218-312-3005
  • Fax: 218-312-3003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberMN43125
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberMN43125
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License NumberMN43125
License Number StateMN
# 4
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number43125
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: