Provider Demographics
NPI:1538212931
Name:DANIEL UROLOGICAL CENTER INCORPORATED
Entity type:Organization
Organization Name:DANIEL UROLOGICAL CENTER INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:PAGE
Authorized Official - Last Name:DANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-584-1010
Mailing Address - Street 1:1041 KIRKPATRICK RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-8148
Mailing Address - Country:US
Mailing Address - Phone:336-584-1010
Mailing Address - Fax:336-584-4005
Practice Address - Street 1:1041 KIRKPATRICK RD
Practice Address - Street 2:SUITE 250
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-8148
Practice Address - Country:US
Practice Address - Phone:336-584-1010
Practice Address - Fax:336-584-4005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC34967174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890180BMedicaid
NC8926955Medicaid
NC2320670Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
NC2169970EMedicare ID - Type UnspecifiedMEDICARE INDIVIDUAL
NC8926955Medicaid