Basic Information
Provider Information
NPI: 1033558879
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ACKIL
FirstName: DANIEL
MiddleName: JOHN
NamePrefix: DR.
NameSuffix:  
Credential: DO
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4227 RALEIGH ST
Address2:  
City: DENVER
State: CO
PostalCode: 80212
CountryCode: US
TelephoneNumber: (802) 735-6155
FaxNumber:  
Practice Location
Address1: 455 TOLL GATE RD
Address2:  
City: WARWICK
State: RI
PostalCode: 028862759
CountryCode: US
TelephoneNumber: 4017377000
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/14/2013
LastUpdateDate: 06/08/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207P00000X0058200COY Allopathic & Osteopathic PhysiciansEmergency Medicine 
390200000XLP02772RIN Student, Health CareStudent in an Organized Health Care Education/Training Program 

No ID Information.


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