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General NPI Number Information
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NPI Number | 1205043361
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Entity Type | Organization
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Legal Business Name | KEITH B DANIELS DPM PC
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 06/11/2008
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Provider Practice Location Address
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Address Line | 2811 E COURT ST
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City | FLINT
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State | MI
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Zip | 48506-4054
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Country | US
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Telephone | 810-424-3338
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Fax | 810-424-3226
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Provider Business Mailing Address
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Address Line | 2811 E COURT STE B PO BOX 228
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City | FLINT
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State | MI
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Zip | 48501
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Country | US
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Telephone | 810-424-3338
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KEITH B DANIELS
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Credential | DPM
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Telephone | 810-424-3338
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | KD001100
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License Number State | MI
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