Provider Demographics
NPI:1376631077
Name:BADE, DANIEL JOSEPH (DO)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:JOSEPH
Last Name:BADE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1850 GATEWAY DR STE 100
Mailing Address - Street 2:
Mailing Address - City:SYCAMORE
Mailing Address - State:IL
Mailing Address - Zip Code:60178-3192
Mailing Address - Country:US
Mailing Address - Phone:815-217-3252
Mailing Address - Fax:815-756-4941
Practice Address - Street 1:1850 GATEWAY DR STE 100
Practice Address - Street 2:
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-3192
Practice Address - Country:US
Practice Address - Phone:815-217-3252
Practice Address - Fax:815-756-4941
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ND17046207Q00000X
AZ4046207P00000X
MI5101020833207Q00000X
MT91382207Q00000X
NH21116207Q00000X
RIDO01055207Q00000X
SDTP343207Q00000X
VT162.0000025207Q00000X
WI1033207Q00000X
HIDOS-2138207Q00000X
MEDO3172207Q00000X
IL036128349207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZI42202Medicare UPIN