Individual
DR. DANIELA HUERTA DE HATHAWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
650 DAKOTA ST STE A, CRYSTAL LAKE, IL 60012
(815) 338-6600
(815) 356-1104
Mailing address
650 DAKOTA ST STE A, CRYSTAL LAKE, IL 60012-3744
(815) 338-6600
(815) 356-1104
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036127309
IL
207R00000X
Internal Medicine Physician
125054385
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036127309
STATE LICENSE
IL
05
—
036127309
—
IL
01
—
P01069683
RR MEDICARE PTAN
IL
Enumeration date
06/23/2008
Last updated
10/19/2018
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