Individual
PATRICIA M O'DONNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPM
Contact information
Practice address
885 ROOSEVELT RD, GLEN ELLYN, IL 60137-6141
(630) 225-2663
(630) 225-2399
Mailing address
885 ROOSEVELT RD, GLEN ELLYN, IL 60137-6141
(630) 225-2663
(630) 225-2399
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
0016004785
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
016004785
MEDICAID
IL
01
—
206147
MEDICARE PTAN (GROUP)
IL
01
—
F400181111
MEDICARE PTAN (INDIVIDUAL)
IL
Enumeration date
03/06/2007
Last updated
05/05/2015
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