Basic Information
| Provider Information | |||||||||
| NPI: | 1548205925 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | O'LEARY | ||||||||
| FirstName: | HELEN | ||||||||
| MiddleName: | TERESA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 MALLARD CREEK RD | ||||||||
| Address2: | SUITE 320 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402074194 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5026908782 | ||||||||
| FaxNumber: | 5024590923 | ||||||||
| Practice Location | |||||||||
| Address1: | 332 W BROADWAY | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402022130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025830909 | ||||||||
| FaxNumber: | 5025830913 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2006 | ||||||||
| LastUpdateDate: | 09/23/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 37773 | KY | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 64067903 | 05 | KY | MEDICAID |