Individual
BERNARD EDWARD O'MALLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
13539 IL ROUTE 76, POPLAR GROVE, IL 61065-8815
(815) 765-0147
(815) 765-0427
Mailing address
13539 IL ROUTE 76, POPLAR GROVE, IL 61065-8815
(815) 765-0147
(815) 765-0427
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036047509
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036047509
—
IL
01
—
553180
MEDICARE GROUP NUMBER
IL
Enumeration date
07/01/2006
Last updated
05/20/2009
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