MEDICARE: KEITH OSMOND O'BRIEN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	35-08-2150-0	OH
2	207R00000X	Internal Medicine Physician	ME101224	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124024625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEITH OSMOND O'BRIEN MD

Provider Business Mailing Address
First Line	:	COMMUNITY HOSPITALISTS, LLC
Second Line	:	PO BOX 39413
City	:	CLEVELAND
State	:	OH
Zip	:	44139
Country	:	US
Telephone Number	:	440-523-5023
Fax Number	:	440-523-5029

Provider Business Practice Location Address
First Line	:	SOUTHWEST GENERAL HEALTH CENTER
Second Line	:	18697 BAGLEY ROAD
City	:	MIDDLEBURG HEIGHTS
State	:	OH
Zip	:	44130
Country	:	US
Telephone Number	:	440-816-8000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	07/21/2022

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