Basic Information
| Provider Information | |||||||||
| NPI: | 1215951710 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DALL'OLMO | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | PILADE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10850 E TRAVERSE HWY | ||||||||
| Address2: | SUITE 60 | ||||||||
| City: | TRAVERSE CITY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 496841364 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2319350497 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10850 E TRAVERSE HWY | ||||||||
| Address2: | SUITE 60 | ||||||||
| City: | TRAVERSE CITY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 496841364 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2319350497 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2006 | ||||||||
| LastUpdateDate: | 01/13/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 4301046222 | MI | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0204X | 4301046222 | MI | N | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology |
ID Information
| ID | Type | State | Issuer | Description | 1774375 | 05 | MI | MEDICAID | 300047532 | 01 | MI | RAILROAD MEDICARE | OTHER |