Provider Demographics
NPI:1598335804
Name:O'NEIL, MARCUS I
Entity Type:Individual
Prefix:
First Name:MARCUS
Middle Name:I
Last Name:O'NEIL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3031 W GRAND BLVD STE 531
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-3008
Mailing Address - Country:US
Mailing Address - Phone:313-664-0100
Mailing Address - Fax:313-664-0111
Practice Address - Street 1:3031 W GRAND BLVD STE 531
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-3008
Practice Address - Country:US
Practice Address - Phone:313-664-0100
Practice Address - Fax:313-664-0111
Is Sole Proprietor?:No
Enumeration Date:2021-06-29
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator