Provider Demographics
NPI:1497874754
Name:JOHN F O'LEARY MD PA
Entity Type:Organization
Organization Name:JOHN F O'LEARY MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN REIMBURSEMENT SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:JYL
Authorized Official - Middle Name:R
Authorized Official - Last Name:DINVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:CCS-P
Authorized Official - Phone:402-397-5462
Mailing Address - Street 1:PO BOX 27015
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68127-0015
Mailing Address - Country:US
Mailing Address - Phone:402-393-9459
Mailing Address - Fax:402-397-9895
Practice Address - Street 1:2545 CHICAGO AVE
Practice Address - Street 2:SUITE 510
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-4522
Practice Address - Country:US
Practice Address - Phone:952-285-6879
Practice Address - Fax:952-285-6890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN24502208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30712800Medicaid
MN00949-OLOtherBCBS GROUP #
MN3D011OLOtherBCBS PIN
MNC04261Medicare ID - Type UnspecifiedGROUP #
MNA94446Medicare UPIN