Healthcare Provider Details

I. General information

NPI: 1073884615
Provider Name (Legal Business Name): MCNEAL-OBRIEN TEAM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2012
Last Update Date: 01/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25800 NORTHWESTERN HWY SUITE 150
SOUTHFIELD MI
48075-8403
US

IV. Provider business mailing address

25800 NORTHWESTERN HWY SUITE 150
SOUTHFIELD MI
48075-8403
US

V. Phone/Fax

Practice location:
  • Phone: 248-594-7722
  • Fax: 248-327-3089
Mailing address:
  • Phone: 248-594-7722
  • Fax: 248-327-3089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number3320150
License Number StateDC

VIII. Authorized Official

Name: MS. CHERYL MCNEAL
Title or Position: CEO
Credential: CLT (HEW)
Phone: 248-594-7722