Provider Demographics
NPI:1871507541
Name:SCHULMAN, DANIEL JAY (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:JAY
Last Name:SCHULMAN
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 1:414 DIVISION DR
Mailing Address - Street 2:
Mailing Address - City:SUGAR GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60554-5109
Mailing Address - Country:US
Mailing Address - Phone:630-315-1010
Mailing Address - Fax:630-315-1005
Practice Address - Street 1:414 DIVISION DR
Practice Address - Street 2:
Practice Address - City:SUGAR GROVE
Practice Address - State:IL
Practice Address - Zip Code:60554-5109
Practice Address - Country:US
Practice Address - Phone:630-315-1010
Practice Address - Fax:630-315-1005
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036068021208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036068021Medicaid
ILF400103207OtherMEDICARE INDIVIDUAL PTAN
IL920540OtherMEDICARE GROUP PTAN