Individual
SEAN O'MALLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
900 N 1ST ST, SPRINGFIELD, IL 62702-3749
(217) 528-7541
Mailing address
PO BOX 19248, SPRINGFIELD, IL 62794-9248
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
036169485
IL
Other
Enumeration date
06/19/2019
Last updated
11/07/2024
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