Healthcare Provider Details

I. General information

NPI: 1982231171
Provider Name (Legal Business Name): CONOR O'NEILL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2020
Last Update Date: 06/21/2023
Certification Date: 06/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 BRECKENRIDGE LN STE 310
LOUISVILLE KY
40220-1402
US

IV. Provider business mailing address

900 S LIMESTONE CTW 304
LEXINGTON KY
40536-0293
US

V. Phone/Fax

Practice location:
  • Phone: 502-928-5000
  • Fax: 502-928-5001
Mailing address:
  • Phone: 859-323-9918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number58154
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: