Provider Demographics
NPI:1114948890
Name:SAMO, DANIEL G (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:G
Last Name:SAMO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3470 N LAKE SHORE DR
Mailing Address - Street 2:APT 24B
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-2881
Mailing Address - Country:US
Mailing Address - Phone:773-327-0774
Mailing Address - Fax:773-327-7983
Practice Address - Street 1:2150 PFINGSTEN RD
Practice Address - Street 2:SUITE 3000
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-1361
Practice Address - Country:US
Practice Address - Phone:847-657-1700
Practice Address - Fax:847-657-1715
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
IL207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D15119Medicare UPIN