Provider Demographics
NPI:1629009956
Name:O'NEIL, STEPHEN J (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:J
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 1:6626 E 75TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:701 EAST COUNTY LINE ROAD
Practice Address - Street 2:SUITE 201
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-1071
Practice Address - Country:US
Practice Address - Phone:317-865-8000
Practice Address - Fax:317-865-8012
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01054157A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000197875OtherANTHEM BLUE CROSS
IN7098286OtherAETNA ELIGIBILITY ID
IN020050030OtherMEDICARE RAILROAD
IN11046216OtherCAQH ID
INP01157063OtherRR MEDICARE PTAN
IN000000010506OtherMDWISE/PROHEALTH
IN200345690AMedicaid
IN11046216OtherCAQH ID
INP01157063OtherRR MEDICARE PTAN
IN266180008Medicare PIN