Provider Demographics
NPI:1437224441
Name:O'ROURKE, DANIEL J (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:J
Last Name:O'ROURKE
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 1:4302 W CRYSTAL LAKE RD STE B
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-4248
Mailing Address - Country:US
Mailing Address - Phone:815-344-3277
Mailing Address - Fax:815-344-9388
Practice Address - Street 1:4302 W CRYSTAL LAKE RD STE B
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-4248
Practice Address - Country:US
Practice Address - Phone:815-344-3277
Practice Address - Fax:815-344-9388
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-064378207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC47737Medicare UPIN
IL750110Medicare ID - Type Unspecified