Provider Demographics
NPI:1518981612
Name:ODELL, SEAN DANIEL (MD)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:DANIEL
Last Name:ODELL
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:PO BOX 807
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60009-0807
Mailing Address - Country:US
Mailing Address - Phone:847-437-9889
Mailing Address - Fax:847-944-1250
Practice Address - Street 1:901 BIESTERFIELD RD STE 300
Practice Address - Street 2:
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-7324
Practice Address - Country:US
Practice Address - Phone:847-437-9889
Practice Address - Fax:847-437-4149
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36112610207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00376430OtherMEDICARE RAILROAD
IL036112610Medicaid
OH2570089Medicaid
IL36112610OtherSTATE LICENSE
IL212020OtherMEDICARE ID-TYPE UNSPECIF
IL36112610OtherSTATE LICENSE
ILI33411Medicare UPIN
IL036112610Medicaid