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General NPI Number Information
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NPI Number | 1447832316
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Entity Type | Individual
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Provider Name | JOHN O'CONNOR
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Gender | Male
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Dates
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Enumeration Date | 04/21/2021
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Last Update Date | 11/02/2023
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Provider Practice Location Address
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Address Line | 44201 DEQUINDRE RD
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City | TROY
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State | MI
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Zip | 48085-1117
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Country | US
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Telephone | 248-964-8193
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Fax |
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Provider Business Mailing Address
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Address Line | 26901 BEAUMONT BLVD STE 3D
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City | SOUTHFIELD
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State | MI
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Zip | 48033-3849
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Country | US
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Telephone | 947-522-1848
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Fax | 947-522-0307
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 4704285734
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 4704285734
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License Number State | MI
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