Provider Demographics
NPI:1033117890
Name:ONEILL, TIMOTHY R (DO)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:R
Last Name:ONEILL
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:5701 BOW POINTE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-3199
Mailing Address - Country:US
Mailing Address - Phone:248-625-2621
Mailing Address - Fax:248-625-2622
Practice Address - Street 1:5701 BOW POINTE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-3199
Practice Address - Country:US
Practice Address - Phone:248-625-2621
Practice Address - Fax:248-625-2622
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2020-02-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MITO020249207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP01235913OtherRAILROAD MEDICARE IND PIN
MI1033117890Medicaid
MIP00943552OtherRAILROAD MEDICARE IND PIN
MI0856315424OtherBCBS IND
MII64433Medicare UPIN
MI1033117890Medicaid
MI1033117890Medicaid
MI0M39080041Medicare PIN
MIMI3292009Medicare PIN