Healthcare Provider Details

I. General information

NPI: 1073636924
Provider Name (Legal Business Name): DANIEL O'NEIL M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2007
Last Update Date: 10/18/2025
Certification Date: 10/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2075 W BIG BEAVER RD SUITE 520
TROY MI
48084-3407
US

IV. Provider business mailing address

870 GOLF DR APT 201
PONTIAC MI
48341-2392
US

V. Phone/Fax

Practice location:
  • Phone: 248-646-6659
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: