Provider Demographics
NPI:1215957568
Name:GIACOMO, DANIEL (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:GIACOMO
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Gender:M
Credentials:MD
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Mailing Address - Street 1:2650 RIDGE AVE
Mailing Address - Street 2:EVANSTON HOSPITAL
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1718
Mailing Address - Country:US
Mailing Address - Phone:847-570-1206
Mailing Address - Fax:847-570-1248
Practice Address - Street 1:909 DAVIS ST
Practice Address - Street 2:SUITE 160
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-3645
Practice Address - Country:US
Practice Address - Phone:847-425-6400
Practice Address - Fax:847-425-6408
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2020-12-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL0360894672084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
E82540Medicare UPIN