Provider Demographics
NPI:1093782831
Name:MCDONNELL, JAMES FORD (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:FORD
Last Name:MCDONNELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2160 S FIRST AVE
Mailing Address - Street 2:(LUH - NO. ENT., RM 2601)
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153
Mailing Address - Country:US
Mailing Address - Phone:708-216-3408
Mailing Address - Fax:708-216-3557
Practice Address - Street 1:2160 S FIRST AVE
Practice Address - Street 2:(LUH - NO. ENT., RM 2601)
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153
Practice Address - Country:US
Practice Address - Phone:708-216-3408
Practice Address - Fax:708-216-3557
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36073690207W00000X, 208000000X
IL036073690207WX0110X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0110XAllopathic & Osteopathic PhysiciansOphthalmologyPediatric Ophthalmology and Strabismus Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36073690Medicaid
IL36073690Medicaid
F13074Medicare UPIN
ILL80283Medicare ID - Type Unspecified