Provider Demographics
NPI:1104872944
Name:SULLIVAN, DANIEL PATRICK (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:PATRICK
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 S MEYERS RD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:OAKBROOK TERRACE
Mailing Address - State:IL
Mailing Address - Zip Code:60181-5243
Mailing Address - Country:US
Mailing Address - Phone:630-873-7305
Mailing Address - Fax:630-416-3189
Practice Address - Street 1:133 E BRUSH HILL RD
Practice Address - Street 2:SUITE 202
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-5658
Practice Address - Country:US
Practice Address - Phone:630-782-4050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036069322207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
060030018OtherRAILROAD MEDICARE
IL036069322Medicaid
060030018OtherRAILROAD MEDICARE
IL036069322Medicaid