MEDICARE: DR. KEVIN A OCONNOR M.D.

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	2084P0800X	Psychiatry Physician	34055	MN
2	2084P0800X	Psychiatry Physician	G48495	CA
3	2084P0800X	Psychiatry Physician	24835	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2156268	OTHER	MN	CIGNA BEHAVIORAL HEALTH
2	962321000211	OTHER	MN	PREFERRED ONE COMM HEALTH
3	103013	OTHER	MN	U CARE
4	1500271	OTHER	MN	MEDICA
5	104891600	OTHER		DEPARTMENT OF LABOR
6	962321000211	OTHER	MN	PREFERRED ONE
7	962321000211	OTHER	MN	PREFERRED ON ADMIN SERVIC
8	19118	OTHER	MN	HEALTH PARTNER
9	5K3920C	OTHER	MN	BC
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396743670
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN A OCONNOR M.D.

Provider Business Mailing Address
First Line	:	6545 FRANCE AVE S
Second Line	:	#671
City	:	EDINA
State	:	MN
Zip	:	55435-2131
Country	:	US
Telephone Number	:	952-829-1853
Fax Number	:	952-922-5047

Provider Business Practice Location Address
First Line	:	6545 FRANCE AVE S
Second Line	:	#671
City	:	EDINA
State	:	MN
Zip	:	55435-2131
Country	:	US
Telephone Number	:	952-829-1853
Fax Number	:	952-922-5047

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

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	05/05/2009

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