Provider Demographics
NPI:1215913652
Name:GARRISON, DANIEL LEE (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:LEE
Last Name:GARRISON
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 1:29373 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-5114
Mailing Address - Country:US
Mailing Address - Phone:847-390-5900
Mailing Address - Fax:630-856-9933
Practice Address - Street 1:4025 N WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-3726
Practice Address - Country:US
Practice Address - Phone:773-275-7700
Practice Address - Fax:773-279-6504
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036121658208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00673340OtherMEDICARE RAILROAD
IL036121658Medicaid
ILP00673340OtherMEDICARE RAILROAD
IL605710001Medicare PIN
IL547700001Medicare PIN