Provider Demographics
NPI:1043369275
Name:O'DONNELL, JAMES R (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:R
Last Name:O'DONNELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:10745 165TH ST
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-8713
Mailing Address - Country:US
Mailing Address - Phone:708-364-5700
Mailing Address - Fax:708-745-3120
Practice Address - Street 1:10745 165TH ST
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-8713
Practice Address - Country:US
Practice Address - Phone:708-364-5700
Practice Address - Fax:708-745-3120
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.070374208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01615715OtherBLUE CROSS BLUE SHIELD
IL036070374Medicaid
IL01615715OtherBLUE CROSS BLUE SHIELD
IL036070374Medicaid