Provider Demographics
NPI:1336588342
Name:DANIEL, CALEB ALBERT (DO)
Entity Type:Individual
Prefix:DR
First Name:CALEB
Middle Name:ALBERT
Last Name:DANIEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1925 HUNTLEY RD
Mailing Address - Street 2:
Mailing Address - City:WEST DUNDEE
Mailing Address - State:IL
Mailing Address - Zip Code:60118-9301
Mailing Address - Country:US
Mailing Address - Phone:815-338-6600
Mailing Address - Fax:847-426-5162
Practice Address - Street 1:1925 HUNTLEY RD
Practice Address - Street 2:
Practice Address - City:WEST DUNDEE
Practice Address - State:IL
Practice Address - Zip Code:60118
Practice Address - Country:US
Practice Address - Phone:815-338-6600
Practice Address - Fax:847-426-5162
Is Sole Proprietor?:No
Enumeration Date:2013-06-24
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125063887207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036139320OtherSTATE LICENSE