1164763363 NPI number — DAWN MARIE O'CONNOR MA, MS, LLP

Table of content: DAWN MARIE O'CONNOR MA, MS, LLP (NPI 1164763363)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164763363 NPI number — DAWN MARIE O'CONNOR MA, MS, LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
O'CONNOR
Provider First Name:
DAWN
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA, MS, LLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KRULL
Provider Other First Name:
DAWN
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA, MS, LLP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1164763363
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/08/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
23231 WOODWARD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FERNDALE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48220-1361
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-581-8777
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
23231 WOODWARD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FERNDALE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48220-1361
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-581-8777
Provider Business Practice Location Address Fax Number:
888-975-9374
Provider Enumeration Date:
03/13/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  6361007574 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1164763363 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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