Individual
DANIEL O'MALLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
820 ROUTE 59, BARTLETT, IL 60103-1300
(630) 483-5930
(630) 483-5939
Mailing address
820 ROUTE 59, BARTLETT, IL 60103-1300
(630) 483-5930
(630) 483-5939
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036-077350
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036077350
MEDICAID
IL
01
—
920540
MEDICARE PTAN (GROUP)
IL
01
—
920540045
MEDICARE PTAN (INDIVIDUAL)
IL
01
—
CA4748
RAILROAD MEDICARE PTAN (GROUP)
IL
01
—
P01281271
RAILROAD MEDICARE PTAN (INDIVIDUAL)
IL
Enumeration date
06/19/2006
Last updated
03/17/2018
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