Provider Demographics
NPI:1154304848
Name:DONNELL, AARON THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:THOMAS
Last Name:DONNELL
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 1:2551 N CLARK ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-1798
Mailing Address - Country:US
Mailing Address - Phone:773-388-2322
Mailing Address - Fax:773-388-2333
Practice Address - Street 1:2551 N CLARK ST
Practice Address - Street 2:SUITE 100
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-1798
Practice Address - Country:US
Practice Address - Phone:773-388-2322
Practice Address - Fax:773-388-2333
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036108892207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036108892Medicaid
H60015Medicare UPIN
ILIL1765001Medicare PIN
ILILIL1765001Medicare PIN
IL036108892Medicaid
ILIL1765Medicare PIN