Provider Demographics
NPI:1669466066
Name:ONEILL, BRIAN A (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:A
Last Name:ONEILL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:4600 MEMORIAL DR STE 400
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62226-5366
Mailing Address - Country:US
Mailing Address - Phone:618-235-0460
Mailing Address - Fax:618-235-1464
Practice Address - Street 1:4600 MEMORIAL DR
Practice Address - Street 2:STE. 220
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62226-5368
Practice Address - Country:US
Practice Address - Phone:618-235-6191
Practice Address - Fax:618-235-6716
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036046574207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036046574Medicaid
D10040Medicare UPIN
IL036046574Medicaid
IL231150Medicare ID - Type Unspecified