Provider Demographics
NPI:1225346281
Name:TIMOTHY OCONNOR MD PC
Entity Type:Organization
Organization Name:TIMOTHY OCONNOR MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:OCONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:906-253-9374
Mailing Address - Street 1:333 MAGAZINE ST
Mailing Address - Street 2:STE 102
Mailing Address - City:SAULT SAINTE MARIE
Mailing Address - State:MI
Mailing Address - Zip Code:49783-1867
Mailing Address - Country:US
Mailing Address - Phone:906-253-9374
Mailing Address - Fax:906-253-9002
Practice Address - Street 1:333 MAGAZINE ST
Practice Address - Street 2:STE 102
Practice Address - City:SAULT SAINTE MARIE
Practice Address - State:MI
Practice Address - Zip Code:49783-1867
Practice Address - Country:US
Practice Address - Phone:906-253-9374
Practice Address - Fax:906-253-9002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-23
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301058216385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4249083Medicaid
MIG16457Medicare UPIN
MI4249083Medicaid