Provider Demographics
NPI:1316944044
Name:MIKESELL, DANNY D (DO)
Entity type:Individual
Prefix:
First Name:DANNY
Middle Name:D
Last Name:MIKESELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:684 HARVEY ST
Mailing Address - Street 2:STE 201
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49442-4274
Mailing Address - Country:US
Mailing Address - Phone:231-773-7837
Mailing Address - Fax:231-773-7943
Practice Address - Street 1:684 HARVEY ST
Practice Address - Street 2:STE 201
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-4274
Practice Address - Country:US
Practice Address - Phone:231-773-7837
Practice Address - Fax:231-773-7943
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2011-01-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MIDM007231208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1777116Medicaid
B42925Medicare UPIN