Provider Demographics
NPI:1447549571
Name:O'HALLORAN, EILEEN ANNE (MD)
Entity type:Individual
Prefix:DR
First Name:EILEEN
Middle Name:ANNE
Last Name:O'HALLORAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:EILEEN
Other - Middle Name:ANNE
Other - Last Name:BOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:607 S NEW BALLAS RD STE 2350
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-0001
Mailing Address - Country:US
Mailing Address - Phone:314-251-1340
Mailing Address - Fax:
Practice Address - Street 1:607 S NEW BALLAS RD STE 2350
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-0001
Practice Address - Country:US
Practice Address - Phone:314-251-1340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-29
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.134096208600000X
MO2024028245208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL125.060396OtherSTATE OF ILLINOIS DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION
IL036.134096OtherILLINOIS DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION