Provider Demographics
NPI:1043495401
Name:DANIEL M. HAYCRAFT MD, PC
Entity Type:Organization
Organization Name:DANIEL M. HAYCRAFT MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:HAYCRAFT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-581-1890
Mailing Address - Street 1:5225 OLD ORCHARD RD
Mailing Address - Street 2:SUITE 34
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-4405
Mailing Address - Country:US
Mailing Address - Phone:847-581-1890
Mailing Address - Fax:847-581-1895
Practice Address - Street 1:5225 OLD ORCHARD RD
Practice Address - Street 2:SUITE 34
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-4405
Practice Address - Country:US
Practice Address - Phone:847-581-1890
Practice Address - Fax:847-581-1895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-04
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK23750Medicare UPIN
IL212794Medicare PIN