Provider Demographics
NPI:1215943808
Name:ONEILL, MICHAEL JAMES (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JAMES
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 1:240 BEACON LITE RD
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-9106
Mailing Address - Country:US
Mailing Address - Phone:719-419-7490
Mailing Address - Fax:719-309-6847
Practice Address - Street 1:240 BEACON LITE RD
Practice Address - Street 2:
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132-9106
Practice Address - Country:US
Practice Address - Phone:719-419-7490
Practice Address - Fax:719-309-6847
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO50683207Q00000X
CODR.0050683207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR149427Medicaid
OR149427Medicaid
D86852Medicare UPIN