Healthcare Provider Details

I. General information

NPI: 1336521582
Provider Name (Legal Business Name): DANIEL D BOHL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2015
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 W HARRISON ST STE 400
CHICAGO IL
60612-4861
US

IV. Provider business mailing address

1611 W HARRISON ST STE 400
CHICAGO IL
60612-4861
US

V. Phone/Fax

Practice location:
  • Phone: 312-432-2300
  • Fax:
Mailing address:
  • Phone: 312-432-2600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number125067143
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: