Healthcare Provider Details

I. General information

NPI: 1932425188
Provider Name (Legal Business Name): AMY MARIE O'CONNOR D.O., MSCI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2010
Last Update Date: 05/22/2020
Certification Date: 05/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E CHICAGO AVE # 21
CHICAGO IL
60611-2991
US

IV. Provider business mailing address

225 E CHICAGO AVE # 21
CHICAGO IL
60611-2991
US

V. Phone/Fax

Practice location:
  • Phone: 312-227-4100
  • Fax: 312-227-9640
Mailing address:
  • Phone: 312-227-4100
  • Fax: 312-227-9640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number036147585
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: