Provider Demographics
NPI:1326049727
Name:DO-DAI, DANIEL D (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:D
Last Name:DO-DAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3264 N EVERGREEN DR NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-9746
Mailing Address - Country:US
Mailing Address - Phone:616-363-7272
Mailing Address - Fax:616-361-5828
Practice Address - Street 1:3264 N EVERGREEN DR NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-9746
Practice Address - Country:US
Practice Address - Phone:616-363-7272
Practice Address - Fax:616-361-5828
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1569892085N0700X, 2085R0202X
MI43015081482085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2116936Medicaid
VA384981OtherANTHEM BCBS
TN4031375OtherBC BS
TNR06903OtherJOHN DEERE
300127902OtherPGBA (RR MEDICARE)
MA0032350OtherNEIGHBORHOOD HEALTH PLAN
MA34296OtherHEALTH NEW ENGLAND
MA96512201OtherNETWORK HEALTH
MAFALLONOther116562
MA622209UMASOtherHARVARD PILGRIM HEALTHCAR
MA009745OtherTUFTS HEALTH PLAN
VA7241984Medicaid
TN3870323Medicaid
KY64048093Medicaid
MAJ40342OtherBLUE CROSS & BLUE SHIELD
MA2116936Medicaid
MAJ40342OtherBLUE CROSS & BLUE SHIELD
VA384981OtherANTHEM BCBS