Provider Demographics
NPI:1891317160
Name:O'NEILL, ELIZABETH SUSAN (MD MPH)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:SUSAN
Last Name:O'NEILL
Suffix:
Gender:F
Credentials:MD MPH
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1016 W MADISON ST APT 4N
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-2079
Mailing Address - Country:US
Mailing Address - Phone:610-704-5060
Mailing Address - Fax:
Practice Address - Street 1:1620 W HARRISON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3801
Practice Address - Country:US
Practice Address - Phone:610-704-5060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-10
Last Update Date:2020-05-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL125.075707208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery