Healthcare Provider Details

I. General information

NPI: 1871507541
Provider Name (Legal Business Name): DANIEL JAY SCHULMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 12/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 DIVISION DR
SUGAR GROVE IL
60554-5109
US

IV. Provider business mailing address

414 DIVISION DR
SUGAR GROVE IL
60554-5109
US

V. Phone/Fax

Practice location:
  • Phone: 630-315-1010
  • Fax: 630-315-1005
Mailing address:
  • Phone: 630-315-1010
  • Fax: 630-315-1005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036068021
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: