=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417577024
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MATTHEW CHRISTOPHER O'BRIEN DO
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/23/2020
-----------------------------------------------------
Last Update Date | 10/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3200 E RACINE ST
-----------------------------------------------------
City | JANESVILLE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53546-2343
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-371-8000
-----------------------------------------------------
Fax | 608-373-8713
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 515 22ND AVE
-----------------------------------------------------
City | MONROE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53566-1569
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-639-6360
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | 81821
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------