Provider Demographics
NPI:1760757561
Name:MORRIS, IVAN DANIEL (DO)
Entity type:Individual
Prefix:
First Name:IVAN
Middle Name:DANIEL
Last Name:MORRIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1790 S CANFIELD RD
Mailing Address - Street 2:
Mailing Address - City:EATON RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:48827-9301
Mailing Address - Country:US
Mailing Address - Phone:517-881-6864
Mailing Address - Fax:
Practice Address - Street 1:2852 EYDE PKWY STE 175
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-5378
Practice Address - Country:US
Practice Address - Phone:517-333-4600
Practice Address - Fax:517-333-4996
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-13
Last Update Date:2024-10-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101019806207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine