Provider Demographics
NPI:1932425188
Name:O'CONNOR, AMY MARIE (DO, MSCI)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MARIE
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:DO, MSCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 E CHICAGO AVE # 21
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2991
Mailing Address - Country:US
Mailing Address - Phone:312-227-4100
Mailing Address - Fax:312-227-9640
Practice Address - Street 1:225 E CHICAGO AVE # 21
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2991
Practice Address - Country:US
Practice Address - Phone:312-227-4100
Practice Address - Fax:312-227-9640
Is Sole Proprietor?:No
Enumeration Date:2010-04-13
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL0361475852080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program