Individual
MAURA P O'CONNELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
19020 FORT ST, RIVERVIEW, MI 48193-6701
(734) 362-5100
(734) 362-5147
Mailing address
19020 FORT ST, RIVERVIEW, MI 48193-6701
(734) 362-5100
(734) 362-5147
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
5101015548
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
139473
MERCY CARE CHOICES
MI
01
—
16834
MCARE
MI
01
—
2401684
UHC
MI
05
—
4612263
—
MI
01
—
5101015548
PHYSICIAN LICENSE
MI
01
—
700H21076
BCBSM
MI
01
—
7262536
AETNA
MI
01
—
9714265
CIGNA
MI
01
—
CC33713
RR MEDICARE
MI
Enumeration date
05/22/2006
Last updated
02/26/2010
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