Provider Demographics
NPI:1235110958
Name:OW, EARL PHILIP (MD)
Entity Type:Individual
Prefix:MR
First Name:EARL
Middle Name:PHILIP
Last Name:OW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:621 PLAINFIELD RD
Mailing Address - Street 2:#105
Mailing Address - City:WILLOW BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60527-5343
Mailing Address - Country:US
Mailing Address - Phone:630-321-9811
Mailing Address - Fax:630-321-9813
Practice Address - Street 1:4440 W 95TH ST
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2600
Practice Address - Country:US
Practice Address - Phone:708-684-5580
Practice Address - Fax:708-684-4068
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL0360503982080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200029140OtherINDYPA
IL036050398Medicaid
IL036050398Medicaid
C45458Medicare UPIN