Provider Demographics
NPI:1053369496
Name:DANIELS, RICHARD J (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:J
Last Name:DANIELS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:719 W HAMILTON AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-6968
Mailing Address - Country:US
Mailing Address - Phone:715-832-1044
Mailing Address - Fax:715-832-0520
Practice Address - Street 1:719 W HAMILTON AVE
Practice Address - Street 2:SUITE C
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-6968
Practice Address - Country:US
Practice Address - Phone:715-832-1044
Practice Address - Fax:715-832-0520
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI37705208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI45049OtherSECURITY HEALTH
WIHP27679OtherHEALTH PARTNERS
WI1700505OtherSELECT CARE/MEDICA
WI020031296OtherRAILROAD MEDICARE
WI32223100Medicaid
WI1700505OtherSELECT CARE/MEDICA
WI000220255Medicare ID - Type Unspecified