=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962655589
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DANIEL A DUFFY DO PLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/28/2008
-----------------------------------------------------
Last Update Date | 03/08/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3340 HOSPITAL RD
-----------------------------------------------------
City | SAGINAW
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48603-9622
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-797-3129
-----------------------------------------------------
Fax | 989-797-3106
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 801 JOE MANN BLVD STE P6
-----------------------------------------------------
City | MIDLAND
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48642-8900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-791-2455
-----------------------------------------------------
Fax | 989-791-1392
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DANIEL A DUFFY
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 989-797-3129
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208100000X
-----------------------------------------------------
Taxonomy Name | Physical Medicine & Rehabilitation Physician
-----------------------------------------------------
License Number | 5101012051
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------