Provider Demographics
NPI:1528143971
Name:O'HALLORAN, RICHARD LEWIS (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:LEWIS
Last Name:O'HALLORAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:927 BROADWAY ST
Mailing Address - Street 2:SUITE 303
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-2719
Mailing Address - Country:US
Mailing Address - Phone:217-223-8400
Mailing Address - Fax:217-222-9807
Practice Address - Street 1:1102 N COUNTY ROAD 700
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:IL
Practice Address - Zip Code:62379-3011
Practice Address - Country:US
Practice Address - Phone:217-256-4100
Practice Address - Fax:217-222-9807
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2023-11-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036089108208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL211041Medicare PIN
MO000013544Medicare PIN