Basic Information
| Provider Information | |||||||||
| NPI: | 1477693901 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ONEESE | ||||||||
| FirstName: | JUSTIN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 781076 | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482781076 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3175284800 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1201 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | CROWN POINT | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463078481 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2197382100 | ||||||||
| FaxNumber: | 2199332288 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2007 | ||||||||
| LastUpdateDate: | 06/06/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 01079420A | IN | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 4301100204 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208D00000X | 2006-00244 | NC | N | Allopathic & Osteopathic Physicians | General Practice | 208M00000X | MD2015-0025 | NM | N | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | 01079420A | IN | Y | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.