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General NPI Number Information
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NPI Number | 1851401129
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Entity Type | Individual
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Provider Name | MARY M OCONNOR D.O.
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Gender | Female
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 5701 BOW POINTE DR STE 365
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City | CLARKSTON
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State | MI
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Zip | 48346
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Country | US
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Telephone | 248-922-9283
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Fax | 248-922-9286
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Provider Business Mailing Address
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Address Line | 5701 BOW POINTE DR STE 365
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City | CLARKSTON
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State | MI
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Zip | 48346-5403
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Country | US
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Telephone | 248-922-9283
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Fax | 248-922-9286
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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 | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 5101015287
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License Number State | MI
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