Healthcare Provider Details

I. General information

NPI: 1811056559
Provider Name (Legal Business Name): JOHN V O'HARA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 02/27/2020
Certification Date: 02/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 S MCLEAN BLVD
ELGIN IL
60123-6703
US

IV. Provider business mailing address

415 W GOLF RD STE 3
ARLINGTON HEIGHTS IL
60005-3923
US

V. Phone/Fax

Practice location:
  • Phone: 847-632-9919
  • Fax:
Mailing address:
  • Phone: 630-221-8000
  • Fax: 844-273-7876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number036070333
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: