Basic Information
Provider Information
NPI: 1598867236
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: OLAND
FirstName: PAUL
MiddleName:  
NamePrefix:  
NameSuffix: JR.
Credential: DO
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1 KISH HOSPITAL DR
Address2:  
City: DEKALB
State: IL
PostalCode: 601159602
CountryCode: US
TelephoneNumber: 8157667334
FaxNumber: 8157669768
Practice Location
Address1: 1 KISH HOSPITAL DR
Address2:  
City: DEKALB
State: IL
PostalCode: 601159602
CountryCode: US
TelephoneNumber: 8157667334
FaxNumber: 8157669768
Other Information
ProviderEnumerationDate: 09/02/2006
LastUpdateDate: 01/18/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 01/18/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207P00000X036098148ILY Allopathic & Osteopathic PhysiciansEmergency Medicine 

No ID Information.


Home