Provider Demographics
NPI:1669403432
Name:DALTON, DANIEL P (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:P
Last Name:DALTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:676 N SAINT CLAIR ST
Mailing Address - Street 2:SUITE 1835
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2927
Mailing Address - Country:US
Mailing Address - Phone:312-926-3535
Mailing Address - Fax:312-926-3585
Practice Address - Street 1:676 N SAINT CLAIR ST
Practice Address - Street 2:SUITE 1835
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2927
Practice Address - Country:US
Practice Address - Phone:312-926-3535
Practice Address - Fax:312-926-3585
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-070600208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL212210008Medicare PIN
K07390Medicare PIN
IL340004664Medicare PIN
ILE18978Medicare UPIN
IL0521470001Medicare NSC