Provider Demographics
NPI:1609858547
Name:CO, DANIEL R (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:R
Last Name:CO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MRS
Other - First Name:JILL
Other - Middle Name:A
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:300 READ ST
Mailing Address - Street 2:STE C
Mailing Address - City:LOCKPORT
Mailing Address - State:IL
Mailing Address - Zip Code:60441-3265
Mailing Address - Country:US
Mailing Address - Phone:815-838-7965
Mailing Address - Fax:815-300-3784
Practice Address - Street 1:300 READ ST
Practice Address - Street 2:STE C
Practice Address - City:LOCKPORT
Practice Address - State:IL
Practice Address - Zip Code:60441-3265
Practice Address - Country:US
Practice Address - Phone:815-838-7965
Practice Address - Fax:815-300-3784
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-16
Last Update Date:2020-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036087966207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine