Provider Demographics
NPI:1467412163
Name:O'NEIL, PATRICK R (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:R
Last Name:O'NEIL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2320 CONCORD RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47909-2708
Mailing Address - Country:US
Mailing Address - Phone:317-567-2180
Mailing Address - Fax:317-567-2191
Practice Address - Street 1:2320 CONCORD RD
Practice Address - Street 2:SUITE C
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47909-2708
Practice Address - Country:US
Practice Address - Phone:317-567-2180
Practice Address - Fax:317-567-2191
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-25
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01026331207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100231530Medicaid
IN050044213OtherRAILROAD MEDICARE
IN100231530Medicaid
IN804750Medicare PIN