Individual
DR. DANIEL THOMAS O CARROLL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM, DABPS
Contact information
Practice address
22W654 BUTTERFIELD RD, GLEN ELLYN, IL 60137-6957
(630) 790-4442
(630) 790-9472
Mailing address
PO BOX 4497, WHEATON, IL 60189-4497
(630) 790-4442
(630) 790-9472
Taxonomy
Speciality
Code
Description
License number
State
213ES0000X
Sports Medicine Podiatrist
Primary
016-003265
IL
213ES0103X
Foot & Ankle Surgery Podiatrist
016-003265
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
016003265
—
IL
01
—
626570
MEDICARE PTAN
IL
Enumeration date
08/31/2005
Last updated
06/10/2024
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