Provider Demographics
NPI:1679661821
Name:SUGIMOTO, DANNY HIROSHI (MD)
Entity Type:Individual
Prefix:DR
First Name:DANNY
Middle Name:HIROSHI
Last Name:SUGIMOTO
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 1:800 S WELLS ST
Mailing Address - Street 2:SUITE M-15
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-4529
Mailing Address - Country:US
Mailing Address - Phone:312-431-6765
Mailing Address - Fax:312-431-7959
Practice Address - Street 1:800 S WELLS ST
Practice Address - Street 2:SUITE M-15
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-4529
Practice Address - Country:US
Practice Address - Phone:312-431-6765
Practice Address - Fax:312-431-7959
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC51222Medicare UPIN