Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RX0202X | Medical Oncology | 19215 | MN |
NPI | 1033110259 |
---|---|
Provider Name | Dr. Michael John O'connell |
First Address | Rochester, MN 55902-6643 |
Second Address | Rochester, MN 55902-6643 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2005 |
Last Update Date | 03/09/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0018913800001 | (05) | PA |
056379 | (02) | PA |
E51408 | (02) | PA |