Provider Demographics
NPI:1760458483
Name:O'MALLEY, DEBRA J (MD)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:J
Last Name:O'MALLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6803 KINGERY HWY
Mailing Address - Street 2:
Mailing Address - City:WILLOWBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60527-5154
Mailing Address - Country:US
Mailing Address - Phone:630-323-0430
Mailing Address - Fax:
Practice Address - Street 1:675 W NORTH AVE
Practice Address - Street 2:SUITE 512
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-1634
Practice Address - Country:US
Practice Address - Phone:708-681-7643
Practice Address - Fax:708-681-7860
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036103645207VC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VC0200XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0361036451Medicaid
ILP00312563OtherRAILROAD MEDICARE
IL0001636283OtherBCBS
IL213704Medicare PIN
ILP00312563OtherRAILROAD MEDICARE