Provider Demographics
NPI:1871544874
Name:PILLOW, DAN (PHD)
Entity type:Individual
Prefix:DR
First Name:DAN
Middle Name:
Last Name:PILLOW
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 CHESHIRE CT
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-4517
Mailing Address - Country:US
Mailing Address - Phone:248-299-4315
Mailing Address - Fax:
Practice Address - Street 1:200 DIVERSION ST
Practice Address - Street 2:SUITE 150
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-2267
Practice Address - Country:US
Practice Address - Phone:248-299-4315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-14
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301003394103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N63780Medicare PIN