Provider Demographics
NPI:1902981970
Name:OCONNELL, DENIS J (DO)
Entity Type:Individual
Prefix:
First Name:DENIS
Middle Name:J
Last Name:OCONNELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1555 BARRINGTON RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-1019
Mailing Address - Country:US
Mailing Address - Phone:847-519-7602
Mailing Address - Fax:847-519-7604
Practice Address - Street 1:1555 BARRINGTON RD
Practice Address - Street 2:SUITE 106
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-1019
Practice Address - Country:US
Practice Address - Phone:847-519-7602
Practice Address - Fax:847-519-7604
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036060648207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036060648Medicaid
674040Medicare ID - Type Unspecified
D14670Medicare UPIN