Provider Demographics
NPI:1578686432
Name:FAISAL, DANIEL O (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:O
Last Name:FAISAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5594 S OAK ST
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-5017
Mailing Address - Country:US
Mailing Address - Phone:630-589-4030
Mailing Address - Fax:630-241-1543
Practice Address - Street 1:8311 ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:FOREST PARK
Practice Address - State:IL
Practice Address - Zip Code:60130-2529
Practice Address - Country:US
Practice Address - Phone:630-589-4030
Practice Address - Fax:630-241-1543
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-07
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-0546242084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036054624Medicaid
ILC42392Medicare UPIN
IL036054624Medicaid