Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 016-003265 | IL |
Y | 213ES0000X | Sports Medicine | 016-003265 | IL |
N | 213ES0103X | Foot & Ankle Surgery | 016-003265 | IL |
NPI | 1437142858 |
---|---|
Provider Name | Dr. Daniel Thomas O Carroll |
First Address | Wheaton, IL 60189-4497 |
Second Address | Glen Ellyn, IL 60137-6957 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2005 |
Last Update Date | 27/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
016003265 | (05) | IL |
626570 | MEDICARE PTAN (01) | IL |
T36984 | (02) | IL |