Healthcare Provider Details

I. General information

NPI: 1922867464
Provider Name (Legal Business Name): AALIYAH O'CONNELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2024
Last Update Date: 03/11/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5841 S MARYLAND AVE
CHICAGO IL
60637-1443
US

IV. Provider business mailing address

2434 N HARDING AVE UNIT G
CHICAGO IL
60647-8013
US

V. Phone/Fax

Practice location:
  • Phone: 773-702-6118
  • Fax:
Mailing address:
  • Phone: 319-270-4490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085010631
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: