MEDICARE: BETSY S OBRIEN 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	2084P0800X	Psychiatry Physician	036.146150	IL

General Provider Information

NPI Number	:	1407172257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETSY S OBRIEN MD

Provider Business Mailing Address
First Line	:	4525 N RAVENSWOOD AVE STE 201
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-5201
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4525 N RAVENSWOOD AVE
Second Line	:	STE 201
City	:	CHICAGO
State	:	IL
Zip	:	60640-5201
Country	:	US
Telephone Number	:	312-878-4520
Fax Number	:	708-575-8311

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

Provider Enumeration Date	:	04/19/2010
Last Update Date	:	01/20/2020

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