Provider Demographics
NPI:1679573240
Name:KUESIS, DANIEL T (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:T
Last Name:KUESIS
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 1:555 BIESTERFIELD RD
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-3306
Mailing Address - Country:US
Mailing Address - Phone:847-690-1776
Mailing Address - Fax:847-690-1777
Practice Address - Street 1:555 BIESTERFIELD RD
Practice Address - Street 2:
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-3306
Practice Address - Country:US
Practice Address - Phone:847-690-1776
Practice Address - Fax:847-690-1777
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-26
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-106102207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036106102Medicaid
IL01637533OtherBCBSIL
IL200045103OtherRAILROAD MEDICARE #
IL01637533OtherBCBSIL
ILK39904Medicare PIN