Basic Information
| Provider Information | |||||||||
| NPI: | 1255585501 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DANIEL VERBURG MD PLC | ||||||||
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| OtherOrganizationName: | VERBURG GYNECOLOGY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2390 MITCHELL PARK DR STE D | ||||||||
| Address2: | |||||||||
| City: | PETOSKEY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 497708965 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2314879355 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2390 MITCHELL PARK DR STE D | ||||||||
| Address2: | |||||||||
| City: | PETOSKEY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 497708965 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2314879355 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/13/2008 | ||||||||
| LastUpdateDate: | 01/15/2009 | ||||||||
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| AuthorizedOfficialLastName: | VERBURG | ||||||||
| AuthorizedOfficialFirstName: | DANIEL | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2314879355 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VG0400X | 4301035417 | MI | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology |
No ID Information.