Provider Demographics
NPI:1992720320
Name:MCCORMICK, DANIEL P (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:P
Last Name:MCCORMICK
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 1:3700 W 203RD ST
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA FIELDS
Mailing Address - State:IL
Mailing Address - Zip Code:60461-1180
Mailing Address - Country:US
Mailing Address - Phone:708-679-2029
Mailing Address - Fax:708-422-7816
Practice Address - Street 1:3700 W 203RD ST
Practice Address - Street 2:
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1180
Practice Address - Country:US
Practice Address - Phone:708-679-2029
Practice Address - Fax:708-422-7816
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036090519207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036090519Medicaid
110223090Medicare PIN
IL634050Medicare PIN
ILF46996Medicare UPIN