Provider Demographics
NPI:1174753313
Name:BRODY, DANIEL WILLIAM (DO)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:WILLIAM
Last Name:BRODY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1601 GOLF COURSE ROAD
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55744
Mailing Address - Country:US
Mailing Address - Phone:218-326-3401
Mailing Address - Fax:218-999-1461
Practice Address - Street 1:1601 GOLF COURSE ROAD
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55744
Practice Address - Country:US
Practice Address - Phone:218-326-3401
Practice Address - Fax:218-999-1461
Is Sole Proprietor?:No
Enumeration Date:2009-07-22
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA4420207RC0000X
MN61003207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease