Provider Demographics
NPI:1043377245
Name:MICHAEL J. O'LEARY, M.D., INC.
Entity Type:Organization
Organization Name:MICHAEL J. O'LEARY, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:O'LEARY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-229-4903
Mailing Address - Street 1:3590 CAMINO DEL RIO N
Mailing Address - Street 2:STE 101
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-1716
Mailing Address - Country:US
Mailing Address - Phone:619-229-4903
Mailing Address - Fax:
Practice Address - Street 1:3590 CAMINO DEL RIO N
Practice Address - Street 2:STE 101
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-1716
Practice Address - Country:US
Practice Address - Phone:619-229-4903
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG56751207YX0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & NeurotologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G567510Medicaid
CAE65054Medicare UPIN