Provider Demographics
NPI:1588612626
Name:O'CONNELL, JOHN (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:O'CONNELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1835 ROHLWING RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:ROLLING MEADOWS
Mailing Address - State:IL
Mailing Address - Zip Code:60008-1394
Mailing Address - Country:US
Mailing Address - Phone:847-951-4451
Mailing Address - Fax:847-398-8360
Practice Address - Street 1:1835 ROHLWING RD
Practice Address - Street 2:SUITE A
Practice Address - City:ROLLING MEADOWS
Practice Address - State:IL
Practice Address - Zip Code:60008-1394
Practice Address - Country:US
Practice Address - Phone:847-951-4451
Practice Address - Fax:847-398-8360
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036094139207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL080183974OtherMEDICARE RAILROAD
IL036094139Medicaid
IL036094139Medicaid
IL962341Medicare PIN
ILIL8016001Medicare PIN
ILP01163034Medicare PIN
ILIL8014001Medicare PIN