Healthcare Provider Details

I. General information

NPI: 1487643763
Provider Name (Legal Business Name): DEBRA O'CONNOR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2835 N SHEFFIELD AVE SUITE 104
CHICAGO IL
60675-0001
US

IV. Provider business mailing address

2835 N SHEFFIELD AVE SUITE 200
CHICAGO IL
60675-0001
US

V. Phone/Fax

Practice location:
  • Phone: 773-472-3704
  • Fax: 312-583-3170
Mailing address:
  • Phone: 773-472-3704
  • Fax: 312-583-3170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: