Healthcare Provider Details

I. General information

NPI: 1154329399
Provider Name (Legal Business Name): DANIEL OROZCO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 08/30/2023
Certification Date: 08/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 MINERAL POINT AVE
JANESVILLE WI
53548-2940
US

IV. Provider business mailing address

1000 MINERAL POINT AVE
JANESVILLE WI
53548-2940
US

V. Phone/Fax

Practice location:
  • Phone: 608-756-6826
  • Fax: 608-756-6160
Mailing address:
  • Phone: 608-756-6826
  • Fax: 608-756-6160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number2012003489
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number036106744
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number55311-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: