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General NPI Number Information
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NPI Number | 1124361720
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Entity Type | Individual
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Provider Name | MICHAEL JOHN O'BRIEN D.O.
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Gender | Male
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Dates
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Enumeration Date | 04/02/2013
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Last Update Date | 04/02/2013
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Provider Practice Location Address
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Address Line | 4665 DOUGLAS CIR NW
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City | CANTON
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State | OH
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Zip | 44718-3673
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Country | US
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Telephone | 330-499-5700
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Fax |
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Provider Business Mailing Address
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Address Line | 983 DALBY CIR
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City | UNIONTOWN
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State | OH
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Zip | 44685-6247
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Country | US
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Telephone | 330-933-5410
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 34-006651
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 0102050017
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | DO034371
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License Number State | DC
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