Provider Demographics
NPI:1225226863
Name:HAMPTON, DANIEL W (DO)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:W
Last Name:HAMPTON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5640 NUTONE ST
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53711-1678
Mailing Address - Country:US
Mailing Address - Phone:630-567-3379
Mailing Address - Fax:608-467-7769
Practice Address - Street 1:601 S CENTER AVE
Practice Address - Street 2:
Practice Address - City:MERRILL
Practice Address - State:WI
Practice Address - Zip Code:54452-3404
Practice Address - Country:US
Practice Address - Phone:715-536-5511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036118969207P00000X
WI51777-21207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1225226863Medicaid
IL036118969OtherSTATE LICENSE NUMBER
WIHANPTDANOtherMERCYCARE INSURANCE
ILP00444352/CK6882OtherRAILROAD MEDICARE
IL504945390 1Medicaid
WIP00978294DB7792OtherRR MEDICARE
IL4673170001OtherDMERC
IL4673170001OtherDMERC
WIP00978294DB7792OtherRR MEDICARE
ILK47964/203980Medicare PIN