Provider Demographics
NPI:1851401129
Name:OCONNOR, MARY M (DO)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:M
Last Name:OCONNOR
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Gender:F
Credentials:DO
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Mailing Address - Street 1:5701 BOW POINTE DR STE 365
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-5403
Mailing Address - Country:US
Mailing Address - Phone:248-922-9283
Mailing Address - Fax:248-922-9286
Practice Address - Street 1:5701 BOW POINTE DR STE 365
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346
Practice Address - Country:US
Practice Address - Phone:248-922-9283
Practice Address - Fax:248-922-9286
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2022-07-21
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Provider Licenses
StateLicense IDTaxonomies
MI5101015287207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4834181-11Medicaid
MI4834181-11Medicaid