Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 014004040 | IL |
NPI | 1336208842 |
---|---|
Provider Name | Dr. Daniel L Syverson |
First Address | Roscoe, IL 61073-0311 |
Second Address | Roscoe, IL 61073-4612 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2006 |
Last Update Date | 29/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
016004040 | (05) | IL |
T38617 | (02) | IL |