Provider Demographics
NPI:1962402636
Name:HARRISON, DANIEL JEROME (MD)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:JEROME
Last Name:HARRISON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:20 E OGDEN AVE
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3543
Mailing Address - Country:US
Mailing Address - Phone:630-655-1229
Mailing Address - Fax:630-655-0185
Practice Address - Street 1:20 E OGDEN AVE
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3543
Practice Address - Country:US
Practice Address - Phone:630-655-1229
Practice Address - Fax:630-655-0185
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
C39376Medicare UPIN
ILP03424Medicare PIN