Healthcare Provider Details

I. General information

NPI: 1174752588
Provider Name (Legal Business Name): DANIEL WILLIAM GOLDEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2009
Last Update Date: 09/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5841 S MARYLAND AVE MC 9006
CHICAGO IL
60637-1447
US

IV. Provider business mailing address

5758 S MARYLAND AVE MC 9006
CHICAGO IL
60637-1426
US

V. Phone/Fax

Practice location:
  • Phone: 773-702-6870
  • Fax: 773-834-7340
Mailing address:
  • Phone: 773-702-6870
  • Fax: 773-834-7340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number036132890
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: