Healthcare Provider Details

I. General information

NPI: 1659496198
Provider Name (Legal Business Name): DANIEL WEIR HARDY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 S STATE ST
ELGIN IL
60123-7612
US

IV. Provider business mailing address

6N171 GLENDALE RD
MEDINAH IL
60157-9725
US

V. Phone/Fax

Practice location:
  • Phone: 847-742-1040
  • Fax:
Mailing address:
  • Phone: 630-307-9028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: