Healthcare Provider Details

I. General information

NPI: 1952368896
Provider Name (Legal Business Name): SEAN P OBRIEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 08/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1535 GULL RD SUITE 020
KALAMAZOO MI
49048-1650
US

IV. Provider business mailing address

1535 GULL RD SUITE 020
KALAMAZOO MI
49048-1650
US

V. Phone/Fax

Practice location:
  • Phone: 269-381-4577
  • Fax: 269-381-6409
Mailing address:
  • Phone: 269-381-4577
  • Fax: 269-381-6409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberSO059838
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberSO059838
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: