Provider Demographics
NPI:1871521286
Name:OCONNOR, KEVIN JAMES (DPM)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:JAMES
Last Name:OCONNOR
Suffix:
Gender:M
Credentials:DPM
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Mailing Address - Street 1:19801 GOVERNORS HWY
Mailing Address - Street 2:SUITE 150
Mailing Address - City:FLOSSMOOR
Mailing Address - State:IL
Mailing Address - Zip Code:60422-4362
Mailing Address - Country:US
Mailing Address - Phone:708-799-2900
Mailing Address - Fax:708-799-2919
Practice Address - Street 1:19801 GOVERNORS HWY
Practice Address - Street 2:SUITE 150
Practice Address - City:FLOSSMOOR
Practice Address - State:IL
Practice Address - Zip Code:60422-4362
Practice Address - Country:US
Practice Address - Phone:708-799-2900
Practice Address - Fax:708-799-2919
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2014-10-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL016003696213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1635864Medicare ID - Type Unspecified
IL5678600001Medicare NSC
ILT38328Medicare UPIN