Provider Demographics
NPI:1952319410
Name:OLEN, RICHARD NEAL (MD)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:NEAL
Last Name:OLEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:7447 W TALCOTT
Mailing Address - Street 2:SUITE 427
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-3745
Mailing Address - Country:US
Mailing Address - Phone:773-990-4024
Mailing Address - Fax:773-990-4029
Practice Address - Street 1:7447 W TALCOTT
Practice Address - Street 2:SUITE 427
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-3745
Practice Address - Country:US
Practice Address - Phone:773-631-9699
Practice Address - Fax:773-631-4299
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036075283208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036075283Medicaid
IL020012234OtherRAILROAD MEDICARE