Basic Information
| Provider Information | |||||||||
| NPI: | 1700250073 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MICHAEL J ONEILL MD PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1465 KELLY JOHNSON BLVD | ||||||||
| Address2: | SUITE 310 | ||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809203955 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7194197490 | ||||||||
| FaxNumber: | 7193096847 | ||||||||
| Practice Location | |||||||||
| Address1: | 1465 KELLY JOHNSON BLVD | ||||||||
| Address2: | SUITE 310 | ||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809203955 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7194197490 | ||||||||
| FaxNumber: | 7193096847 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/24/2015 | ||||||||
| LastUpdateDate: | 01/26/2016 | ||||||||
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| AuthorizedOfficialLastName: | O'NEILL | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7194651849 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.