MEDICARE: MICHAEL ANTHONY DANIELS DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	36003516	OH
2	213E00000X	Podiatrist	6818	NY
3	213E00000X	Podiatrist	N006818	NY

General Provider Information

NPI Number	:	1700119336
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL ANTHONY DANIELS DPM

Provider Business Mailing Address
First Line	:	382 WHITE SPRUCE BLVD
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14623-1604
Country	:	US
Telephone Number	:	585-424-2420
Fax Number	:	585-424-2422

Provider Business Practice Location Address
First Line	:	382 WHITE SPRUCE BLVD
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14623-1604
Country	:	US
Telephone Number	:	585-424-2420
Fax Number	:	585-424-2422

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2009
Last Update Date	:	07/03/2023

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