Healthcare Provider Details

I. General information

NPI: 1992334783
Provider Name (Legal Business Name): KYLE O'BRIEN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2020
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 S OSPREY AVE UNIT 101
SARASOTA FL
34239-3608
US

IV. Provider business mailing address

1801 S OSPREY AVE UNIT 101
SARASOTA FL
34239-3608
US

V. Phone/Fax

Practice location:
  • Phone: 941-621-9497
  • Fax:
Mailing address:
  • Phone: 941-621-9497
  • Fax: 941-219-5360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS22832
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: