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General NPI Number Information
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NPI Number | 1669791893
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Entity Type | Individual
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Provider Name | MICHAEL MCCONNELL D.O.
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Gender | Male
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Dates
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Enumeration Date | 05/27/2010
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Last Update Date | 05/08/2025
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Provider Practice Location Address
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Address Line | 12490 BUSINESS CENTER DR STE 200
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City | VICTORVILLE
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State | CA
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Zip | 92395-5833
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Country | US
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Telephone | 760-728-1900
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Fax |
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Provider Business Mailing Address
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Address Line | 1229 BULL VALLEY DR
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City | WOODSTOCK
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State | IL
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Zip | 60098-8084
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Country | US
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Telephone | 847-533-6498
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Fax |
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 20A20719
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 036.139705
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License Number State | IL
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