Provider Demographics
NPI:1972779759
Name:MORGAN-GOERKE, DANIELLE BROOKE (DO)
Entity type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:BROOKE
Last Name:MORGAN-GOERKE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MRS
Other - First Name:DANIELLE
Other - Middle Name:BROOKE
Other - Last Name:MORGAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:6728 POLARIS LN N
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55311-3211
Mailing Address - Country:US
Mailing Address - Phone:816-456-0511
Mailing Address - Fax:
Practice Address - Street 1:F282/2A WEST 2450 RIVERSIDE AVE.
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454
Practice Address - Country:US
Practice Address - Phone:612-273-9800
Practice Address - Fax:612-273-9779
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-01
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MN261QM1300X2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1972779759OtherBLUE CROSS/ BLUE SHIELD OF MN
MN52497OtherMINNESOTA MEDICAL LICENSE
MN52497OtherMINNESOTA MEDICAL LICENSE