Provider Demographics
NPI:1851476212
Name:VERA, DANIEL E (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:E
Last Name:VERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:35318 EAGLE WAY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60678-1353
Mailing Address - Country:US
Mailing Address - Phone:317-528-4800
Mailing Address - Fax:317-865-8319
Practice Address - Street 1:3700 W 203RD ST STE 201
Practice Address - Street 2:
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1182
Practice Address - Country:US
Practice Address - Phone:708-679-2120
Practice Address - Fax:708-503-3230
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036099679208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL020053761OtherPALMETTO RR MEDICARE
IL036099679Medicaid
IL203979060OtherMEDICARE PTAN -SPI
ILL94086Medicare PIN
ILL91563Medicare UPIN