Provider Demographics
NPI:1972583417
Name:BRUETMAN, DANIEL G (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:G
Last Name:BRUETMAN
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:OUTPATIENT CARE CENTER DOWNTOWN CHICAGO
Mailing Address - Street 2:160 E. ILLINOIS STREET
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611
Mailing Address - Country:US
Mailing Address - Phone:312-477-2400
Mailing Address - Fax:
Practice Address - Street 1:OUTPATIENT CARE CENTER DOWNTOWN CHICAGO
Practice Address - Street 2:160 E. ILLINOIS STREET
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611
Practice Address - Country:US
Practice Address - Phone:312-477-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01054353A207RX0202X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200316750Medicaid
INE19293Medicare UPIN
IN200316750Medicaid