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General NPI Number Information
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NPI Number | 1225185739
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Entity Type | Organization
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Legal Business Name | MICHAEL J. O'CONNELL D.O. INC
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Dates
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Enumeration Date | 01/05/2007
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Last Update Date | 01/21/2011
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Provider Practice Location Address
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Address Line | 17960 CLEVELAND ROAD
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City | SOUTH BEND
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State | IN
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Zip | 46635
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Country | US
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Telephone | 574-287-7205
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Fax | 574-232-5045
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Provider Business Mailing Address
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Address Line | 17960 CLEVELAND ROAD
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City | SOUTH BEND
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State | IN
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Zip | 46635
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Country | US
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Telephone | 574-287-7205
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Fax | 574-232-5045
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. MICHAEL J O'CONNELL
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Credential | D.O.
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Telephone | 574-287-7205
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 02000569A
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License Number State | IN
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