Provider Demographics
NPI:1386965499
Name:DOOLITTLE, OTHNIEL STEPHEN (MD)
Entity type:Individual
Prefix:DR
First Name:OTHNIEL
Middle Name:STEPHEN
Last Name:DOOLITTLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2250 N ILLINOIS AVE
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62901-5612
Mailing Address - Country:US
Mailing Address - Phone:618-833-1691
Mailing Address - Fax:
Practice Address - Street 1:2250 N ILLINOIS AVE
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-5612
Practice Address - Country:US
Practice Address - Phone:618-833-1691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-14
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036133193208M00000X
IL125.058047207R00000X
MO2013004979207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine