=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770796567
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DONNA M O'NEILL M.D. P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/08/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1100 E MICHIGAN AVE SUITE 305
-----------------------------------------------------
City | JACKSON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49201-1847
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 517-788-4781
-----------------------------------------------------
Fax | 517-788-4799
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1100 E MICHIGAN AVE SUITE 305
-----------------------------------------------------
City | JACKSON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49201-1847
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 517-788-4781
-----------------------------------------------------
Fax | 517-788-4799
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MRS. PEGGY L JOHNSON
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 517-788-4781
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RI0200X
-----------------------------------------------------
Taxonomy Name | Infectious Disease Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------