Provider Demographics
NPI:1700373529
Name:CLIFFORD, DANIEL PATRICK
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:PATRICK
Last Name:CLIFFORD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 E. DUNDEE RD.
Mailing Address - Street 2:BLDG. 5/STE #300
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010
Mailing Address - Country:US
Mailing Address - Phone:847-503-0028
Mailing Address - Fax:847-503-0523
Practice Address - Street 1:18 E. DUNDEE RD.
Practice Address - Street 2:BLDG. 5/STE #300
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010
Practice Address - Country:US
Practice Address - Phone:847-503-0028
Practice Address - Fax:847-503-0523
Is Sole Proprietor?:No
Enumeration Date:2018-04-17
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL30015893747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant