MEDICARE: DR. LUCY KATHLEEN O'BRIEN D.O.

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	207Q00000X	Family Medicine Physician	34.011502	OH

General Provider Information

NPI Number	:	1487911814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LUCY KATHLEEN O'BRIEN D.O.

Provider Business Mailing Address
First Line	:	2244 WINFIELD AVE
Second Line	:
City	:	ROCKY RIVER
State	:	OH
Zip	:	44116-2877
Country	:	US
Telephone Number	:	810-624-1675
Fax Number	:	440-743-8131

Provider Business Practice Location Address
First Line	:	303 E ROYALTON RD
Second Line	:
City	:	BROADVIEW HEIGHTS
State	:	OH
Zip	:	44147-2591
Country	:	US
Telephone Number	:	440-743-8130
Fax Number	:	440-743-8131

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

Provider Enumeration Date	:	04/23/2012
Last Update Date	:	02/22/2022

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