Provider Demographics
NPI:1437656592
Name:O'DONNELL, DEBORAH (MD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:O'DONNELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DEBORAH
Other - Middle Name:
Other - Last Name:DANIEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:8896 COMMERCE RD STE 5
Mailing Address - Street 2:
Mailing Address - City:COMMERCE TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48382-4494
Mailing Address - Country:US
Mailing Address - Phone:248-360-9241
Mailing Address - Fax:248-360-0830
Practice Address - Street 1:8896 COMMERCE RD STE 5
Practice Address - Street 2:
Practice Address - City:COMMERCE TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48382-4494
Practice Address - Country:US
Practice Address - Phone:248-982-1085
Practice Address - Fax:248-360-0830
Is Sole Proprietor?:No
Enumeration Date:2018-04-06
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301503881208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics