Provider Demographics
NPI:1427483627
Name:DANSE, ILENE RAISEFELD (MD)
Entity type:Individual
Prefix:DR
First Name:ILENE
Middle Name:RAISEFELD
Last Name:DANSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 MARIN WAY
Mailing Address - Street 2:
Mailing Address - City:BOLINAS
Mailing Address - State:CA
Mailing Address - Zip Code:94924-1106
Mailing Address - Country:US
Mailing Address - Phone:415-868-1043
Mailing Address - Fax:415-868-2671
Practice Address - Street 1:56 MARIN WAY
Practice Address - Street 2:
Practice Address - City:BOLINAS
Practice Address - State:CA
Practice Address - Zip Code:94924-1106
Practice Address - Country:US
Practice Address - Phone:415-868-1043
Practice Address - Fax:415-868-2671
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-06
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist