Provider Demographics
NPI:1821853128
Name:BYNUM, DAISY
Entity Type:Individual
Prefix:
First Name:DAISY
Middle Name:
Last Name:BYNUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7700 S HARLEM AVE APT 1B
Mailing Address - Street 2:
Mailing Address - City:BRIDGEVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60455-1354
Mailing Address - Country:US
Mailing Address - Phone:773-243-7259
Mailing Address - Fax:
Practice Address - Street 1:7700 S HARLEM AVE APT 1B
Practice Address - Street 2:
Practice Address - City:BRIDGEVIEW
Practice Address - State:IL
Practice Address - Zip Code:60455-1354
Practice Address - Country:US
Practice Address - Phone:773-243-7259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty