Basic Information
| Provider Information | |||||||||
| NPI: | 1043499437 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | O'SHEA | ||||||||
| FirstName: | JEREMY | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1088 WILD CHERRY DR | ||||||||
| Address2: | |||||||||
| City: | WILLIAMSTON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488959449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5866511070 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1215 E MICHIGAN AVE | ||||||||
| Address2: | |||||||||
| City: | LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 489121811 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5173370957 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2007 | ||||||||
| LastUpdateDate: | 09/28/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 58002596 | OH | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | OS10943 | FL | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | DO153364 | OR | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 5101016762 | MI | N | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.