Provider Demographics
NPI:1790737021
Name:TROY, DANIEL ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:ANTHONY
Last Name:TROY
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:PO BOX 1844
Mailing Address - Street 2:
Mailing Address - City:BRIDGEVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60455-0844
Mailing Address - Country:US
Mailing Address - Phone:708-599-5000
Mailing Address - Fax:708-599-5000
Practice Address - Street 1:6701 W 95TH ST
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2105
Practice Address - Country:US
Practice Address - Phone:708-599-5000
Practice Address - Fax:708-599-5000
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-096753207XS0117X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036096753Medicaid
IL200040776OtherRAILROAD MEDICARE PROVIDER NUMBER
IL200040776OtherRAILROAD MEDICARE PROVIDER NUMBER
IL1032380001Medicare NSC
ILIL7664001Medicare PIN
ILIL7663001Medicare PIN