MEDICARE: KATHLEEN ELLEN O'BRIEN MD

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	207V00000X	Obstetrics & Gynecology Physician	4301507116	MI
2	207V00000X	Obstetrics & Gynecology Physician	83783	WI

General Provider Information

NPI Number	:	1245725829
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN ELLEN O'BRIEN MD

Provider Business Mailing Address
First Line	:	5774 LONGWOOD LN
Second Line	:
City	:	FITCHBURG
State	:	WI
Zip	:	53711-7211
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5774 LONGWOOD LN
Second Line	:
City	:	FITCHBURG
State	:	WI
Zip	:	53711-7211
Country	:	US
Telephone Number	:	608-445-9796
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2018
Last Update Date	:	03/22/2026

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