Provider Demographics
NPI:1942475298
Name:RIVARD, DANIEL DOUGLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:DOUGLAS
Last Name:RIVARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3880 SALEM LAKE DR
Mailing Address - Street 2:STE F
Mailing Address - City:LONG GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60047-5292
Mailing Address - Country:US
Mailing Address - Phone:847-719-2220
Mailing Address - Fax:847-719-2265
Practice Address - Street 1:800 E 20TH ST STE 350
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-3884
Practice Address - Country:US
Practice Address - Phone:307-996-1560
Practice Address - Fax:307-996-1565
Is Sole Proprietor?:No
Enumeration Date:2008-04-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.119810207R00000X
IL036119810208M00000X
WY10667A208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FR0931825OtherDEA