Provider Demographics
NPI:1386621647
Name:OKEEFE, J PAUL (MD)
Entity type:Individual
Prefix:
First Name:J PAUL
Middle Name:
Last Name:OKEEFE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2160 S 1ST AVE
Mailing Address - Street 2:(1950 S. HARLEM AVE., NORTH RIVERSIDE, IL. 60546)
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153
Mailing Address - Country:US
Mailing Address - Phone:708-354-9250
Mailing Address - Fax:708-354-8765
Practice Address - Street 1:2160 S 1ST AVE
Practice Address - Street 2:(1950 S. HARLEM AVE., NORTH RIVERSIDE, IL. 60546)
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153
Practice Address - Country:US
Practice Address - Phone:708-354-9250
Practice Address - Fax:708-354-8765
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2010-03-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL36047253207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36047253Medicaid
D75391Medicare UPIN
IL491030Medicare ID - Type Unspecified