Provider Demographics
NPI:1689316192
Name:DEVANO, DAN MICHAEL (DO)
Entity type:Individual
Prefix:
First Name:DAN MICHAEL
Middle Name:
Last Name:DEVANO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4512 KIRKWOOD HWY STE 300
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-5129
Mailing Address - Country:US
Mailing Address - Phone:302-623-7500
Mailing Address - Fax:302-623-7505
Practice Address - Street 1:4512 KIRKWOOD HWY STE 300
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-5129
Practice Address - Country:US
Practice Address - Phone:302-623-7500
Practice Address - Fax:302-623-7505
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-13
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC2-0024684207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine