Basic Information
| Provider Information | |||||||||
| NPI: | 1629115977 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HADLEY | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | N5241 US HIGHWAY 45 | ||||||||
| Address2: | |||||||||
| City: | WATERSMEET | ||||||||
| State: | MI | ||||||||
| PostalCode: | 499690009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9063584588 | ||||||||
| FaxNumber: | 9063584588 | ||||||||
| Practice Location | |||||||||
| Address1: | N5241 US HIGHWAY 45 | ||||||||
| Address2: | |||||||||
| City: | WATERSMEET | ||||||||
| State: | MI | ||||||||
| PostalCode: | 499690009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9063584588 | ||||||||
| FaxNumber: | 9063584588 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2007 | ||||||||
| LastUpdateDate: | 06/29/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | DR.0045562 | CO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.