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Individual
DANIEL O'MALLEY
Active
Individual
DANIEL O'MALLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036-077350
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036077350
MEDICAID
IL
01
—
920540
MEDICARE PTAN (GROUP)
IL
01
—
920540045
MEDICARE PTAN (INDIVIDUAL)
IL
01
—
CA4748
RAILROAD MEDICARE PTAN (GROUP)
IL
01
—
P01281271
RAILROAD MEDICARE PTAN (INDIVIDUAL)
IL
Enumeration date
06/19/2006
Last updated
03/17/2018
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