Organization
ODONOGHUE & ROSENOW, MDSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL J ODONOGHUE M.D. (PRESIDENT)
(708) 422-8500
Entity
Organization
Contact information
Practice address
2850 W 95TH ST, SUITE 306, EVERGREEN PARK, IL 60805-2741
(708) 422-8500
(708) 499-7872
Mailing address
2850 W 95TH ST, SUITE 306, EVERGREEN PARK, IL 60805-2741
(708) 422-8500
(708) 499-7872
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
036054095
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01616745
BLUE CROSS BLUE SHIELD
IL
05
—
036054095
—
IL
Enumeration date
06/05/2007
Last updated
01/19/2010
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