MEDICARE: DR. CRISTINA M ODONOGHUE M.D., M.P.H.

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
1	208600000X	Surgery Physician	036.143014	IL
2	208600000X	Surgery Physician	ME123563	FL
3	2086X0206X	Surgical Oncology Physician	036.143014	IL

General Provider Information

NPI Number	:	1508032715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CRISTINA M ODONOGHUE M.D., M.P.H.

Provider Business Mailing Address
First Line	:	1725 W HARRISON ST STE 810
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-3863
Country	:	US
Telephone Number	:	312-942-5500
Fax Number	:	312-563-2080

Provider Business Practice Location Address
First Line	:	1725 W HARRISON ST STE 810
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-3863
Country	:	US
Telephone Number	:	312-942-5500
Fax Number	:	312-563-2080

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/07/2008
Last Update Date	:	03/12/2024

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