Provider Demographics
NPI:1528019767
Name:DALAN, DANILO ANTONIO (MD)
Entity type:Individual
Prefix:DR
First Name:DANILO
Middle Name:ANTONIO
Last Name:DALAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:DAN
Other - Middle Name:
Other - Last Name:DALAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:400 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-1951
Mailing Address - Country:US
Mailing Address - Phone:218-786-8364
Mailing Address - Fax:
Practice Address - Street 1:1702 UNIVERSITY DR S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-4940
Practice Address - Country:US
Practice Address - Phone:701-364-8906
Practice Address - Fax:319-272-5825
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN32309207K00000X
IAMD-46630207KA0200X
ND5708207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND17448Medicaid
ND17448Medicaid
ND5708OtherNORTH DAKOTA LICENSE
ND14468Medicare ID - Type Unspecified