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NPI Code Detail

MEDICARE: EARLENE O'NEAL M.D.

MEDICARE: EARLENE O'NEAL M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LX0001XObstetrics & Gynecology Nurse PractitionerIL

General Provider Information

NPI Number : 1396768172
Entity Type Code : Individual
Provider Name (Legal Business Name) : EARLENE O'NEAL M.D.
Provider Business Mailing Address
First Line : 800 E 55TH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60615-4906
Country : US
Telephone Number : 773-702-2193
Fax Number : 773-702-4356
Provider Business Practice Location Address
First Line : 800 E 55TH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60615-4906
Country : US
Telephone Number : 773-702-2193
Fax Number : 773-702-4356
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/25/2006
Last Update Date : 07/08/2007

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