Healthcare Provider Details

I. General information

NPI: 1194736868
Provider Name (Legal Business Name): SEAN JOSEPH O'CONNOR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1481 W 10TH ST PSYCHIATRY 116P
INDIANAPOLIS IN
46202-2803
US

IV. Provider business mailing address

321 WEST KESSLER BOULEVARD
INDIANAPOLIS IN
46228-1442
US

V. Phone/Fax

Practice location:
  • Phone: 317-988-2514
  • Fax: 317-988-2129
Mailing address:
  • Phone: 317-254-9419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number01039798A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number01039798A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number01039798A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: