Basic Information
| Provider Information | |||||||||
| NPI: | 1497874754 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JOHN F O'LEARY MD PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 27015 | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681270015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4023939459 | ||||||||
| FaxNumber: | 4023979895 | ||||||||
| Practice Location | |||||||||
| Address1: | 2545 CHICAGO AVE | ||||||||
| Address2: | SUITE 510 | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554044522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9522856879 | ||||||||
| FaxNumber: | 9522856890 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2007 | ||||||||
| LastUpdateDate: | 03/04/2008 | ||||||||
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| AuthorizedOfficialLastName: | DINVILLE | ||||||||
| AuthorizedOfficialFirstName: | JYL | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN REIMBURSEMENT SPECIALIST | ||||||||
| AuthorizedOfficialTelephone: | 4023975462 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CCS-P | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 24502 | MN | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 30712800 | 05 | WI | MEDICAID | 00949-OL | 01 | MN | BCBS GROUP # | OTHER | 3D011OL | 01 | MN | BCBS PIN | OTHER |