Provider Demographics
NPI:1952398919
Name:GREENBERG, DANIEL RIGHT (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:RIGHT
Last Name:GREENBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2740 W FOSTER AVE
Mailing Address - Street 2:LL7
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625
Mailing Address - Country:US
Mailing Address - Phone:773-878-8200
Mailing Address - Fax:773-293-4197
Practice Address - Street 1:2740 W FOSTER AVE
Practice Address - Street 2:STE 301
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625
Practice Address - Country:US
Practice Address - Phone:773-271-3139
Practice Address - Fax:773-293-8772
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-04
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036072134207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400195669OtherMEDICARE INDIVIDUAL PTAN
IL036072134OtherMEDICAID NUMBER FOR SCMG
IL036072134Medicaid
IL406120OtherMEDICARE PTAN FOR SCMG
IL036072134OtherMEDICAID NUMBER FOR SCMG
ILE08457Medicare UPIN