Provider Demographics
NPI:1811932056
Name:O'MALLEY, DANIEL (DO)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:O'MALLEY
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 1:820 ROUTE 59
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:IL
Mailing Address - Zip Code:60103-1300
Mailing Address - Country:US
Mailing Address - Phone:630-483-5930
Mailing Address - Fax:630-483-5939
Practice Address - Street 1:820 ROUTE 59
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:IL
Practice Address - Zip Code:60103-1300
Practice Address - Country:US
Practice Address - Phone:630-483-5930
Practice Address - Fax:630-483-5939
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-077350207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL920540045OtherMEDICARE PTAN (INDIVIDUAL)
IL036077350OtherMEDICAID
ILCA4748OtherRAILROAD MEDICARE PTAN (GROUP)
ILP01281271OtherRAILROAD MEDICARE PTAN (INDIVIDUAL)
IL920540OtherMEDICARE PTAN (GROUP)
ILC42778Medicare UPIN