| Richard E Odonnell Do Sc | |
|
3927 W 95th St Evergreen Park IL 60805-1903 | |
| (708) 799-8440 | |
| Not Available |
| Full Name | Richard E Odonnell Do Sc |
|---|---|
| Speciality | Family Medicine |
| Location | 3927 W 95th St, Evergreen Park, Illinois |
| Authorized Official Name and Position | Kim Wylie (OFFICE MANAGER) |
| Authorized Official Contact | 7087998440 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Richard E Odonnell Do Sc 18141 Dixie Hwy Ste 107 Homewood IL 60430-2241 Ph: () - | Richard E Odonnell Do Sc 3927 W 95th St Evergreen Park IL 60805-1903 Ph: (708) 799-8440 |
| NPI Number | 1144421017 |
|---|---|
| Provider Enumeration Date | 05/30/2007 |
| Last Update Date | 10/31/2007 |
| Medicare PECOS PAC ID | 7618064189 |
|---|---|
| Medicare Enrollment ID | O20071030000620 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144421017 | NPI | - | NPPES |
| 01622829 | Other | IL | BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (Illinois) | Primary |
| Provider Name | Richard E Odonnell |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1184600207 PECOS PAC ID: 3173610649 Enrollment ID: I20071030000614 |
Stanley A Polit Md, Sc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2850 W 95th St, Suite 11, Evergreen Park, IL 60805 Phone: 708-424-9044 Fax: 708-424-1799 | |
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