Individual
SEAN DANIEL ODELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
901 BIESTERFIELD RD STE 300, ELK GROVE VILLAGE, IL 60007-7324
(847) 437-9889
(847) 437-4149
Mailing address
PO BOX 807, ELK GROVE VILLAGE, IL 60009-0807
(847) 437-9889
(847) 944-1250
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
36112610
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036112610
—
IL
01
—
212020
MEDICARE ID-TYPE UNSPECIF
IL
05
—
2570089
—
OH
01
—
36112610
STATE LICENSE
IL
01
—
P00376430
MEDICARE RAILROAD
IL
Enumeration date
07/26/2006
Last updated
02/16/2022
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