Provider Demographics
NPI:1992807184
Name:OCONNOR, DENNIS CARL (DO)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:CARL
Last Name:OCONNOR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 439
Mailing Address - Street 2:570 N HEMLOCK
Mailing Address - City:HEMLOCK
Mailing Address - State:MI
Mailing Address - Zip Code:48626
Mailing Address - Country:US
Mailing Address - Phone:989-642-8310
Mailing Address - Fax:989-642-8429
Practice Address - Street 1:570 N HEMLOCK RD
Practice Address - Street 2:POB 439
Practice Address - City:HEMLOCK
Practice Address - State:MI
Practice Address - Zip Code:48626-9622
Practice Address - Country:US
Practice Address - Phone:989-642-8310
Practice Address - Fax:989-642-8429
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MID0007552207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2102850Medicaid
MI382276455OtherCOMMERCIALS
MI0157300015OtherHEALTH PLUS
MI382276455OtherCOMMERCIALS
MI2102850Medicaid