MEDICARE: DANIEL S MCGOWAN JR. MD

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	2085R0202X	Diagnostic Radiology Physician	036178235	IL
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1225615735
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL S MCGOWAN JR. MD

Provider Business Mailing Address
First Line	:	250 E SUPERIOR ST STE 4-2305
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-2914
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	250 E SUPERIOR ST STE 4-2305
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-2914
Country	:	US
Telephone Number	:	312-695-5753
Fax Number	:	312-695-5645

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

Provider Enumeration Date	:	03/29/2021
Last Update Date	:	06/09/2026

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