Provider Demographics
NPI:1063113678
Name:BAMRICK-FERNANDEZ, DANIEL ROBERT (MD, MBA)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:ROBERT
Last Name:BAMRICK-FERNANDEZ
Suffix:
Gender:M
Credentials:MD, MBA
Other - Prefix:MR
Other - First Name:DANIEL
Other - Middle Name:ROBERT
Other - Last Name:BAMRICK
Other - Suffix:JR
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3134 N CLARK ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-4414
Mailing Address - Country:US
Mailing Address - Phone:312-996-6966
Mailing Address - Fax:
Practice Address - Street 1:3134 N CLARK ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-4414
Practice Address - Country:US
Practice Address - Phone:773-975-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-13
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.084285207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine