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1912951807

NPI Code Detail

MEDICARE: MAURA P O'CONNELL D.O.

MEDICARE: MAURA P O'CONNELL D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	5101015548	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
8	CC33713	OTHER	MI	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	700H21076	OTHER	MI	BCBSM
2	9714265	OTHER	MI	CIGNA
3	16834	OTHER	MI	MCARE
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	5101015548	OTHER	MI	PHYSICIAN LICENSE
6	139473	OTHER	MI	MERCY CARE CHOICES
7	7262536	OTHER	MI	AETNA
9	2401684	OTHER	MI	UHC

General Provider Information

NPI Number	:	1912951807
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAURA P O'CONNELL D.O.

Provider Business Mailing Address
First Line	:	19020 FORT ST
Second Line	:
City	:	RIVERVIEW
State	:	MI
Zip	:	48193-6701
Country	:	US
Telephone Number	:	734-362-5100
Fax Number	:	734-362-5147

Provider Business Practice Location Address
First Line	:	19020 FORT ST
Second Line	:
City	:	RIVERVIEW
State	:	MI
Zip	:	48193-6701
Country	:	US
Telephone Number	:	734-362-5100
Fax Number	:	734-362-5147

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2006
Last Update Date	:	02/26/2010

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1093820573 — NORA S CREIGHTON FNP-BC
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Directions to “ MAURA P O'CONNELL D.O.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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