Provider Demographics
NPI:1922054832
Name:O'NEILL, ALFONSO V (MD)
Entity Type:Individual
Prefix:
First Name:ALFONSO
Middle Name:V
Last Name:O'NEILL
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 1:25631 LITTLE MACK AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-2108
Mailing Address - Country:US
Mailing Address - Phone:586-588-9813
Mailing Address - Fax:586-588-9814
Practice Address - Street 1:25631 LITTLE MACK AVE STE 202
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-2108
Practice Address - Country:US
Practice Address - Phone:586-588-9813
Practice Address - Fax:586-588-9814
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAO043730207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI193361310Medicaid
MIE37431Medicare UPIN
MI193361310Medicaid