Provider Demographics
NPI:1164647889
Name:O'CONNOR, KEARY ELIZABETH (DO)
Entity Type:Individual
Prefix:DR
First Name:KEARY
Middle Name:ELIZABETH
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:245 STATE ST SE
Mailing Address - Street 2:STE 221
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503
Mailing Address - Country:US
Mailing Address - Phone:616-685-1808
Mailing Address - Fax:616-685-1850
Practice Address - Street 1:1471 E. BELTLINE NE
Practice Address - Street 2:STE 102
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525
Practice Address - Country:US
Practice Address - Phone:616-685-1490
Practice Address - Fax:616-685-1499
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2009-08-31
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Provider Licenses
StateLicense IDTaxonomies
MI5101016404207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1164647889Medicaid
MIP32930312Medicare PIN
MIM02830190Medicare PIN
MI1164647889Medicaid