Provider Demographics
NPI:1215951710
Name:DALL'OLMO, DANIEL PILADE (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:PILADE
Last Name:DALL'OLMO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10850 E TRAVERSE HWY
Mailing Address - Street 2:SUITE 60
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-1364
Mailing Address - Country:US
Mailing Address - Phone:231-935-0497
Mailing Address - Fax:
Practice Address - Street 1:10850 E TRAVERSE HWY
Practice Address - Street 2:SUITE 60
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-1364
Practice Address - Country:US
Practice Address - Phone:231-935-0497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010462222085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1774375Medicaid
MI300047532OtherRAILROAD MEDICARE
MI1774375Medicaid
MIB86004009Medicare PIN