Organization
DANIEL L SYVERSON DPM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DANIEL L SYVERSON DPM (OWNER)
(815) 389-8088
Entity
Organization
Contact information
Practice address
12360 DUNHAM DR, ROSCOE, IL 61073-9096
(815) 389-8088
Mailing address
PO BOX 311, ROSCOE, IL 61073-0311
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
01600404
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
016004040
—
IL
Enumeration date
03/31/2008
Last updated
04/24/2008
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