Provider Demographics
NPI:1437252749
Name:O'NEIL, LISA (DO)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:O'NEIL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33611 WARREN RD
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-2787
Mailing Address - Country:US
Mailing Address - Phone:734-641-8900
Mailing Address - Fax:734-641-8970
Practice Address - Street 1:33611 WARREN RD
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-2787
Practice Address - Country:US
Practice Address - Phone:734-641-8900
Practice Address - Fax:734-641-8970
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101008960207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0158202565OtherBCN IND
MI110236362OtherRAILROAD MEDICARE IND PIN
MIF03778OtherHAP
MI0158202565OtherBCBS IND
MI1437252749Medicaid
MI5231112OtherAETNA
MI1437252749Medicaid
MI0158202565OtherBCBS IND