Individual
MR. DANIEL GLEN VICKERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
138 SERVICE RD STE D100, EAST LANSING, MI 48824-1313
(517) 353-5053
Mailing address
605 W WESTERN AVE, MUSKEGON, MI 49440-1080
(231) 722-6005
(231) 726-2804
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
5101016856
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1902007644
—
MI
Enumeration date
05/30/2007
Last updated
04/12/2016
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