Basic Information
Provider Information
NPI: 1346483013
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GO
FirstName: DANIEL
MiddleName: C.
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2100 PFINGSTEN RD STE 3001A
Address2:  
City: GLENVIEW
State: IL
PostalCode: 600261301
CountryCode: US
TelephoneNumber: 8475701010
FaxNumber: 8477335108
Practice Location
Address1: 2100 PFINGSTEN RD STE 3001A
Address2:  
City: GLENVIEW
State: IL
PostalCode: 60026
CountryCode: US
TelephoneNumber: 8475701010
FaxNumber: 8477335108
Other Information
ProviderEnumerationDate: 04/10/2009
LastUpdateDate: 10/15/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208M00000X036131096ILY Allopathic & Osteopathic PhysiciansHospitalist 
207R00000X036131096ILN Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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