Healthcare Provider Details

I. General information

NPI: 1528019767
Provider Name (Legal Business Name): DANILO ANTONIO DALAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: DAN DALAN MD

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 06/26/2024
Certification Date: 06/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1702 UNIVERSITY DR S
FARGO ND
58103-4940
US

IV. Provider business mailing address

400 E 3RD ST
DULUTH MN
55805-1951
US

V. Phone/Fax

Practice location:
  • Phone: 701-364-8906
  • Fax: 319-272-5825
Mailing address:
  • Phone: 218-786-8364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number32309
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberMD-46630
License Number StateIA
# 3
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number5708
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: