Provider Demographics
NPI:1831399583
Name:DANIEL, IRINA (DO)
Entity type:Individual
Prefix:
First Name:IRINA
Middle Name:
Last Name:DANIEL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:5019 N MOZART ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-3615
Mailing Address - Country:US
Mailing Address - Phone:773-878-8200
Mailing Address - Fax:773-293-4197
Practice Address - Street 1:6225 W TOUHY AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-1105
Practice Address - Country:US
Practice Address - Phone:773-631-2223
Practice Address - Fax:773-631-5607
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2020-10-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036125559207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL125052971Other125052971