Basic Information
| Provider Information | |||||||||
| NPI: | 1902895741 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | O'DONOGHUE | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | KEVIN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7411 LAKE ST | ||||||||
| Address2: | SUITE 2110 | ||||||||
| City: | RIVER FOREST | ||||||||
| State: | IL | ||||||||
| PostalCode: | 603051876 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7084881122 | ||||||||
| FaxNumber: | 7084881142 | ||||||||
| Practice Location | |||||||||
| Address1: | 804 E WOODFIELD RD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | SCHAUMBURG | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601734776 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8476059500 | ||||||||
| FaxNumber: | 8476058700 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/14/2005 | ||||||||
| LastUpdateDate: | 10/22/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 036040479 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.