Provider Demographics
NPI:1104951250
Name:MIHAILESCU, DAN VALENTIN (MD)
Entity type:Individual
Prefix:
First Name:DAN
Middle Name:VALENTIN
Last Name:MIHAILESCU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1448 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-2803
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1819 W POLK ST
Practice Address - Street 2:SECTION OF ENDOCRINOLOGY (MC 640)
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-4356
Practice Address - Country:US
Practice Address - Phone:312-996-6062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-101988207R00000X
IL036101988207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
185769OtherPROVIDER NUMBER
185769OtherPROVIDER NUMBER