MEDICARE: KEISHA ONEAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	4703106307	MI

General Provider Information

NPI Number	:	1396199022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEISHA ONEAL

Provider Business Mailing Address
First Line	:	22701 ESSEX WAY ST
Second Line	:
City	:	SOUTHFIELD
State	:	MI
Zip	:	48033-3332
Country	:	US
Telephone Number	:	313-452-8889
Fax Number	:

Provider Business Practice Location Address
First Line	:	22701 ESSEX WAY ST
Second Line	:
City	:	SOUTHFIELD
State	:	MI
Zip	:	48033-3332
Country	:	US
Telephone Number	:	313-452-8889
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/19/2016
Last Update Date	:	04/19/2016

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