Provider Demographics
NPI:1104474915
Name:O'NEILL, TARA EILEEN (LM, CPM)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:EILEEN
Last Name:O'NEILL
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38215 W 10 MILE RD STE 6
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48335-2866
Mailing Address - Country:US
Mailing Address - Phone:313-351-5331
Mailing Address - Fax:
Practice Address - Street 1:38215 W 10 MILE RD STE 6
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48335-2866
Practice Address - Country:US
Practice Address - Phone:313-351-5331
Practice Address - Fax:313-751-8101
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-27
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7601000071176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty