Provider Demographics
NPI:1902895741
Name:O'DONOGHUE, JOHN KEVIN (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:KEVIN
Last Name:O'DONOGHUE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:7411 LAKE ST
Mailing Address - Street 2:SUITE 2110
Mailing Address - City:RIVER FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60305-1876
Mailing Address - Country:US
Mailing Address - Phone:708-488-1122
Mailing Address - Fax:708-488-1142
Practice Address - Street 1:804 E WOODFIELD RD
Practice Address - Street 2:SUITE 300
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-4776
Practice Address - Country:US
Practice Address - Phone:847-605-9500
Practice Address - Fax:847-605-8700
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2013-10-22
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Provider Licenses
StateLicense IDTaxonomies
IL036040479207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC37603Medicare UPIN