Basic Information
| Provider Information | |||||||||
| NPI: | 1275760456 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CONGREVE | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | P. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 747 | ||||||||
| Address2: | 1051 WEST SOUTH STREET | ||||||||
| City: | KEWANEE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 61443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3098527700 | ||||||||
| FaxNumber: | 3098527764 | ||||||||
| Practice Location | |||||||||
| Address1: | 1051 WEST SOUTH STREET | ||||||||
| Address2: | |||||||||
| City: | KEWANEE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 61443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3098527700 | ||||||||
| FaxNumber: | 3098527764 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2009 | ||||||||
| LastUpdateDate: | 06/22/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 036-059091 | IL | Y | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 21926 | IA | N | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.