Healthcare Provider Details

I. General information

NPI: 1477819191
Provider Name (Legal Business Name): AILEEN DANKO MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2012
Last Update Date: 03/24/2023
Certification Date: 03/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 W PEACE ST
CANTON MS
39046-4325
US

IV. Provider business mailing address

PO BOX 1549
CANTON MS
39046-1549
US

V. Phone/Fax

Practice location:
  • Phone: 601-407-6104
  • Fax: 601-407-6074
Mailing address:
  • Phone: 601-407-6104
  • Fax: 601-407-6074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License NumberME85303
License Number StateFL

VIII. Authorized Official

Name: AILEEN DANKO
Title or Position: OWNER
Credential: MD
Phone: 954-323-6723