Provider Demographics
NPI:1003923426
Name:STROUPE, DANIEL B (MD)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:B
Last Name:STROUPE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:BOGDAN
Other - Middle Name:
Other - Last Name:CIOBOTARU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:610 S MAPLE AVE STE 4050
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60304-1091
Mailing Address - Country:US
Mailing Address - Phone:083-830-9437
Mailing Address - Fax:708-613-4382
Practice Address - Street 1:610 S MAPLE AVE STE 4050
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60304-1091
Practice Address - Country:US
Practice Address - Phone:708-383-0943
Practice Address - Fax:708-613-4382
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD25513207RI0200X
TXL8650207RI0200X
IL036- 106665207RI0200X
IL036106665207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036106665Medicaid
ILP00418912OtherRAILROAD MEDICARE
IL1618792OtherBCBS
IL1618792OtherBCBS
ILK39042Medicare PIN
ILP00418912OtherRAILROAD MEDICARE