Individual
MICHAEL JAMES OCONNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
17960 CLEVELAND RD, SOUTH BEND, IN 46635-1349
(574) 287-7205
(574) 232-5045
Mailing address
17960 CLEVELAND RD, SOUTH BEND, IN 46635-1349
(574) 287-7205
(574) 232-5045
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02000569A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000095399
ANTHEM BLUE CROSS
IN
Enumeration date
12/22/2005
Last updated
11/17/2009
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