Provider Demographics
NPI:1639141161
Name:O'NEIL, ANGELA E (MD)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:E
Last Name:O'NEIL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10250 N 92ND ST
Mailing Address - Street 2:STE 210
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4519
Mailing Address - Country:US
Mailing Address - Phone:507-319-4679
Mailing Address - Fax:
Practice Address - Street 1:10250 N 92ND ST
Practice Address - Street 2:STE 210
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4519
Practice Address - Country:US
Practice Address - Phone:507-319-4679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN37915207Q00000X
AZ52700207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN552526800Medicaid
MN1639141161OtherNPI NUMBER
MN080089213Medicare ID - Type UnspecifiedRAILROAD
MN552526800Medicaid
G04993Medicare UPIN