Provider Demographics
NPI:1427015973
Name:MARYLAND, DANIEL LUDVIC (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:LUDVIC
Last Name:MARYLAND
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 1:332 EAST CENTRAL ENTRANCE
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811-5514
Mailing Address - Country:US
Mailing Address - Phone:218-722-5871
Mailing Address - Fax:
Practice Address - Street 1:332 EAST CENTRAL ENTRANCE
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55811-5514
Practice Address - Country:US
Practice Address - Phone:218-722-5871
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN14953207W00000X
WI15070020207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN74582MAOtherBLUE CROSS BLUE SHIELD AF
WI31271000Medicaid
HP49310OtherHEALTH PARTNERS
0806038OtherMEDICA
MN112146OtherUCARE
5137060OtherFIRST HEALTH
MN785001OtherPREFERRED ONE
0806038OtherMEDICA