Provider Demographics
NPI:1669401493
Name:O'NEAL, REGINALD EVERETTE (DO)
Entity type:Individual
Prefix:
First Name:REGINALD
Middle Name:EVERETTE
Last Name:O'NEAL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:75 BARCLAY CIR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-5820
Mailing Address - Country:US
Mailing Address - Phone:248-299-2408
Mailing Address - Fax:248-299-2402
Practice Address - Street 1:75 BARCLAY CIR
Practice Address - Street 2:SUITE 105
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-5820
Practice Address - Country:US
Practice Address - Phone:248-299-2408
Practice Address - Fax:248-299-2402
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101007335207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1156319534OtherBCBS
F00552OtherHAP
110004856OtherRAILROAD MEDICARE
1156319534OtherBCN
0000064301503OtherUNITED HEALTH PLAN
5630135Medicare PIN
F00552OtherHAP