Provider Demographics
NPI:1669463022
Name:O'HARA, RAYMOND T (DPM)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:T
Last Name:O'HARA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:929 W HIGGINS RD
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60195-3203
Mailing Address - Country:US
Mailing Address - Phone:847-285-4200
Mailing Address - Fax:847-885-0130
Practice Address - Street 1:929 W HIGGINS RD
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60195-3203
Practice Address - Country:US
Practice Address - Phone:847-285-4200
Practice Address - Fax:847-885-0130
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016-005174213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016005174Medicaid
ILP00311695OtherMEDICARE RAILROAD
ILP00311695OtherMEDICARE RAILROAD
ILP00311695OtherMEDICARE RAILROAD
IL363062013OtherEIN
IL016005174Medicaid