MEDICARE: MICHAEL KEVIN O'SHEA DPM

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	213ES0103X	Foot & Ankle Surgery Podiatrist	E2624	CA

General Provider Information

NPI Number	:	1295846152
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL KEVIN O'SHEA DPM

Provider Business Mailing Address
First Line	:	1201 S HACIENDA BLVD
Second Line	:	SUITE 101
City	:	HACIENDA HTS
State	:	CA
Zip	:	91745-2200
Country	:	US
Telephone Number	:	626-961-1882
Fax Number	:	626-968-7599

Provider Business Practice Location Address
First Line	:	1201 S HACIENDA BLVD
Second Line	:	SUITE 101
City	:	HACIENDA HTS
State	:	CA
Zip	:	91745-2200
Country	:	US
Telephone Number	:	626-961-1882
Fax Number	:	626-968-7599

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	05/19/2022

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