Healthcare Provider Details

I. General information

NPI: 1174782528
Provider Name (Legal Business Name): ELIZABETH ANN O'LEARY M.D., M.H.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2008
Last Update Date: 10/20/2021
Certification Date: 10/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7760 FRANCE AVE S STE 1000
BLOOMINGTON MN
55435-5870
US

IV. Provider business mailing address

2550 UNIVERSITY AVE W STE 110N
SAINT PAUL MN
55114-2001
US

V. Phone/Fax

Practice location:
  • Phone: 952-746-6767
  • Fax:
Mailing address:
  • Phone: 651-602-5309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberD0076284
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD041676
License Number StateDC
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number69403
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: