Healthcare Provider Details

I. General information

NPI: 1881648806
Provider Name (Legal Business Name): DERMOT D OBRIEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4701 TOWNE CTR
SAGINAW MI
48604-2834
US

IV. Provider business mailing address

4449 FASHION SQUARE BLVD
SAGINAW MI
48603-5217
US

V. Phone/Fax

Practice location:
  • Phone: 989-799-1160
  • Fax:
Mailing address:
  • Phone: 989-790-0007
  • Fax: 989-790-7547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301031296
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: