Healthcare Provider Details

I. General information

NPI: 1124025754
Provider Name (Legal Business Name): JOHN FRANCIS O'LEARY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 03/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2545 CHICAGO AVE S STE 510
MINNEAPOLIS MN
55404
US

IV. Provider business mailing address

PO BOX 27015
OMAHA NE
68127-0015
US

V. Phone/Fax

Practice location:
  • Phone: 952-285-6879
  • Fax: 952-285-6890
Mailing address:
  • Phone: 402-393-9459
  • Fax: 402-397-9895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number24502
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: