MEDICARE: OKLAHOMA CENTER FOR ORTHOPAEDIC EXCELLENCE & SPORTS MEDICINE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	3481	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114991304
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OKLAHOMA CENTER FOR ORTHOPAEDIC EXCELLENCE & SPORTS MEDICINE, LLC

Provider Business Mailing Address
First Line	:	PO BOX 890358
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73189-0358
Country	:	US
Telephone Number	:	405-759-2663
Fax Number	:	405-759-3827

Provider Business Practice Location Address
First Line	:	3110 SW 89TH ST
Second Line	:	SUITE 200C
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73159-7919
Country	:	US
Telephone Number	:	405-759-2663
Fax Number	:	405-759-3827

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MICHAEL SEAN OBRIEN
Credential	:	DO
Telephone Number	:	405-759-2663

Provider Enumeration Date	:	02/14/2006
Last Update Date	:	11/17/2011

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