Provider Demographics
NPI:1215907787
Name:ONEILL, LEONARD T (MD)
Entity type:Individual
Prefix:
First Name:LEONARD
Middle Name:T
Last Name:ONEILL
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 1:535 S BURDICK ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-5294
Mailing Address - Country:US
Mailing Address - Phone:269-341-8822
Mailing Address - Fax:269-341-7518
Practice Address - Street 1:535 S BURDICK ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5294
Practice Address - Country:US
Practice Address - Phone:269-341-8822
Practice Address - Fax:269-341-7518
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301046136207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1215907787Medicaid
MI3244331Medicaid
MI1417961137OtherBCBSM - BMH
MICA4396OtherRAILROAD MEDICARE
MIC97618373 - BMHMedicare PIN
D17320Medicare UPIN
MI3244331Medicaid