Provider Demographics
NPI:1215297635
Name:LIENDO, DANIEL (PA)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:LIENDO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 E PARKDALE AVE
Mailing Address - Street 2:
Mailing Address - City:MANISTEE
Mailing Address - State:MI
Mailing Address - Zip Code:49660-9776
Mailing Address - Country:US
Mailing Address - Phone:231-398-1840
Mailing Address - Fax:231-339-6183
Practice Address - Street 1:24350 ORCHARD LAKE RD
Practice Address - Street 2:SUITE 111
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-1970
Practice Address - Country:US
Practice Address - Phone:248-888-7719
Practice Address - Fax:630-528-9507
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-18
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
MI5601006319363L00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner