Provider Demographics
NPI:1144465386
Name:JIMENEZ, DANIEL (DO)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:JIMENEZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 W FLETCHER ST
Mailing Address - Street 2:#4
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-7745
Mailing Address - Country:US
Mailing Address - Phone:773-450-7582
Mailing Address - Fax:
Practice Address - Street 1:904 W FLETCHER ST
Practice Address - Street 2:#4
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-7745
Practice Address - Country:US
Practice Address - Phone:773-450-7582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-02
Last Update Date:2017-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-122152207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine