Basic Information
| Provider Information | |||||||||
| NPI: | 1952680225 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DANIELS | ||||||||
| FirstName: | JONATHAN | ||||||||
| MiddleName: | RICHARD | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2650 RIDGE AVE. | ||||||||
| Address2: | IM HOSPITALISTS STE 4210 | ||||||||
| City: | EVANSTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8475701010 | ||||||||
| FaxNumber: | 8477335108 | ||||||||
| Practice Location | |||||||||
| Address1: | 3801 SPRING ST | ||||||||
| Address2: | |||||||||
| City: | MOUNT PLEASANT | ||||||||
| State: | WI | ||||||||
| PostalCode: | 534051667 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2626874011 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2011 | ||||||||
| LastUpdateDate: | 03/23/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 036134976 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 125059130 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 64884 | WI | N | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | 036134976 | IL | Y | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.