Provider Demographics
NPI:1528660321
Name:GALLAGHER, DANIEL (PA)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:GALLAGHER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5961 N LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-3758
Mailing Address - Country:US
Mailing Address - Phone:312-702-3923
Mailing Address - Fax:
Practice Address - Street 1:5961 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-3758
Practice Address - Country:US
Practice Address - Phone:312-702-3923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-16
Last Update Date:2025-09-04
Deactivation Date:2025-07-31
Deactivation Code:
Reactivation Date:2025-08-15
Provider Licenses
StateLicense IDTaxonomies
IL085010714363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty