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Individual

KENNETH J O'NEILL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
5515 CLEVELAND AVE, STEVENSVILLE, MI 49127-9670
(269) 429-9644
(269) 429-4002
Mailing address
5515 CLEVELAND AVE, STEVENSVILLE, MI 49127-9670
(269) 429-9644
(269) 429-4002

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4301045698
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
110089876
RAILROAD MEDICARE
MI
01
1101107081
BLUE CROSS PIN
MI
05
2893924
MI
Enumeration date
07/31/2006
Last updated
03/07/2023
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