Provider Demographics
NPI:1447028006
Name:ELIZABETH O'LEARY, P.L.L.C
Entity type:Organization
Organization Name:ELIZABETH O'LEARY, P.L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:O'LEARAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:612-482-2118
Mailing Address - Street 1:4514 EDINA BLVD
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55424-1134
Mailing Address - Country:US
Mailing Address - Phone:612-482-2118
Mailing Address - Fax:
Practice Address - Street 1:5775 WAYZATA BLVD STE 190
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-2627
Practice Address - Country:US
Practice Address - Phone:612-482-2118
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-13
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty