Provider Demographics
NPI:1417986613
Name:O'LEARY, MICHAEL JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:O'LEARY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
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:619-229-4947
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:619-229-4947
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG56751207YX0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & Neurotology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G567510Medicaid
CAG56751Medicare ID - Type Unspecified
CAE65054Medicare UPIN