Basic Information
| Provider Information | |||||||||
| NPI: | 1942475298 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RIVARD | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | DOUGLAS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3880 SALEM LAKE DR | ||||||||
| Address2: | STE F | ||||||||
| City: | LONG GROVE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600475292 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8477192220 | ||||||||
| FaxNumber: | 8477192265 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 E 20TH ST STE 350 | ||||||||
| Address2: | |||||||||
| City: | CHEYENNE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 820013884 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3079961560 | ||||||||
| FaxNumber: | 3079961565 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/28/2008 | ||||||||
| LastUpdateDate: | 11/08/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 036.119810 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 036119810 | IL | N | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | 10667A | WY | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 10667A | WY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | FR0931825 | 01 | DEA | OTHER |