Healthcare Provider Details

I. General information

NPI: 1205810439
Provider Name (Legal Business Name): ROBERT B ONEILL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7150 W 20TH AVE STE 612
HIALEAH FL
33016-5529
US

IV. Provider business mailing address

1150 DOVE AVE
MIAMI SPRINGS FL
33166-3102
US

V. Phone/Fax

Practice location:
  • Phone: 305-827-1561
  • Fax: 305-702-9662
Mailing address:
  • Phone: 305-887-3531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME0063187
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: