Provider Demographics
NPI:1174741722
Name:OCARROLL& ASSOCIATES LLC
Entity type:Organization
Organization Name:OCARROLL& ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:O'CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM, DABPS
Authorized Official - Phone:630-790-4442
Mailing Address - Street 1:PO BOX 4497
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60189-4497
Mailing Address - Country:US
Mailing Address - Phone:630-790-4442
Mailing Address - Fax:630-790-9472
Practice Address - Street 1:22W654 BUTTERFIELD RD
Practice Address - Street 2:
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-6957
Practice Address - Country:US
Practice Address - Phone:630-790-4442
Practice Address - Fax:630-790-9472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016-003265213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016003265Medicaid
IL016003265Medicaid
ILT36984Medicare UPIN
IL1145580001Medicare NSC