Healthcare Provider Details

I. General information

NPI: 1104960657
Provider Name (Legal Business Name): MICHAEL J. O'BRIEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2007
Last Update Date: 08/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 TULANE AVE DEPT. OF ORTHOPAEDICS, SL-32, ROOM 2070
NEW ORLEANS LA
70112-2632
US

IV. Provider business mailing address

1430 TULANE AVE DEPT. OF ORTHOPAEDICS, SL-32, ROOM 2070
NEW ORLEANS LA
70112-2632
US

V. Phone/Fax

Practice location:
  • Phone: 504-988-5770
  • Fax: 504-988-3517
Mailing address:
  • Phone: 504-988-5770
  • Fax: 504-988-3517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberMD203048
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: