Provider Demographics
NPI:1306937404
Name:DUGAN, DONALD W (PT)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:W
Last Name:DUGAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 E AURORA ST
Mailing Address - Street 2:
Mailing Address - City:IRONWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49938-2146
Mailing Address - Country:US
Mailing Address - Phone:906-932-0714
Mailing Address - Fax:
Practice Address - Street 1:216 E AURORA ST
Practice Address - Street 2:
Practice Address - City:IRONWOOD
Practice Address - State:MI
Practice Address - Zip Code:49938-2146
Practice Address - Country:US
Practice Address - Phone:906-932-0714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501002422225100000X
WI2653-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40086300Medicaid
MI695131028241OtherPREFERRED ONE
0B75702Medicare ID - Type Unspecified