Healthcare Provider Details

I. General information

NPI: 1952478927
Provider Name (Legal Business Name): DANIEL THOMAS O'CONNOR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 09/23/2021
Certification Date: 09/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2865 N BROOKFIELD RD
BROOKFIELD WI
53045-3026
US

IV. Provider business mailing address

2865 N BROOKFIELD RD
BROOKFIELD WI
53045-3026
US

V. Phone/Fax

Practice location:
  • Phone: 608-628-3690
  • Fax:
Mailing address:
  • Phone: 608-628-3690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number50669
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number50669-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: