Provider Demographics
NPI:1336949551
Name:KACEY, DANIEL
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:KACEY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 N BRUNER ST
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3023
Mailing Address - Country:US
Mailing Address - Phone:630-408-2916
Mailing Address - Fax:
Practice Address - Street 1:1853 W POLK ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-4355
Practice Address - Country:US
Practice Address - Phone:312-996-3500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health