Individual
DR. DANIEL THOMAS DAVISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
6500 W 65TH ST, CHICAGO, IL 60638-4962
(708) 496-1515
(708) 495-1788
Mailing address
6500 W 65TH ST, CHICAGO, IL 60638-4962
(708) 496-1515
(708) 496-1788
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
036059839
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036059839
—
IL
Enumeration date
01/11/2007
Last updated
01/26/2017
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