Individual provider Active NPI

Daniel Ilya Wolfson, MD

  • Neurological Surgery Physician
  • Chicago, IL
National Provider Identifier
1093339830
Registry record updated Jul 11, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
License
125.075801 Issued in IL
Practice address
600 S Paulina St Ste 403
Chicago, IL 60612-3806
Phone
(312) 942-0312
NPI assigned
Jun 6, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Neurological Surgery Physician 207T00000X 125.075801 IL Primary

Addresses

Primary practice location

600 S Paulina St Ste 403
Chicago, IL 60612-3806

Mailing address

600 S Paulina St Ste 403
Chicago, IL 60612-3806
Phone (312) 942-0312

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200723000202 IL Order and Referring Only - NeurosurgeryPractitioner - Neurosurgery 6507280559

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1591401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594425600000",
    "number": "1093339830",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 S PAULINA ST STE 403",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606123806",
            "telephone_number": "312-942-0312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 S PAULINA ST STE 403",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606123806",
            "telephone_number": "312-942-0312"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOLFSON",
        "first_name": "DANIEL",
        "middle_name": "ILYA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-06-06",
        "last_updated": "2020-07-11",
        "certification_date": "2020-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "IL",
            "license": "125.075801",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.