MEDICARE: GREGORY DALY D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	36052957	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	080008227	OTHER	IL	RAILROAD IND PROV #
3	CL4550	OTHER	IL	RAILROAD GROUP #

General Provider Information

NPI Number	:	1780682922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY DALY D.O.

Provider Business Mailing Address
First Line	:	6187 ARCHER AVE
Second Line	:	SUITE 103
City	:	CHICAGO
State	:	IL
Zip	:	60638-2747
Country	:	US
Telephone Number	:	773-581-1500
Fax Number	:	773-581-2160

Provider Business Practice Location Address
First Line	:	6187 ARCHER AVE
Second Line	:	SUITE 103
City	:	CHICAGO
State	:	IL
Zip	:	60638-2747
Country	:	US
Telephone Number	:	773-581-1500
Fax Number	:	773-581-2160

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	12/15/2009

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