Basic Information
| Provider Information | |||||||||
| NPI: | 1922076777 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VERBURG | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2390 MITCHELL PARK DR | ||||||||
| Address2: | UNIT D | ||||||||
| City: | PETOSKEY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 497708965 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2314879355 | ||||||||
| FaxNumber: | 2314871737 | ||||||||
| Practice Location | |||||||||
| Address1: | 2390 MITCHELL PARK DR | ||||||||
| Address2: | UNIT D | ||||||||
| City: | PETOSKEY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 497708965 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2314879355 | ||||||||
| FaxNumber: | 2314871737 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2006 | ||||||||
| LastUpdateDate: | 08/05/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 4301035417 | MI | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 1602410911 | 01 | MI | BCBS | OTHER | 4085801 | 05 | MI | MEDICAID | 160B41011 | 01 | MI | BCBS MI | OTHER | 383445481 | 01 | MI | TAX ID | OTHER | 160046901 | 01 | MI | RR MEDICARE | OTHER | 0B41179 | 01 | MI | BCBS MI | OTHER |