MEDICARE: KEVIN T OCONNOR DO PC

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	208600000X	Surgery Physician	5101010639	MI

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
2	0255900344	OTHER	MI	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1932396942
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KEVIN T OCONNOR DO PC

Provider Business Mailing Address
First Line	:	PO BOX 326
Second Line	:
City	:	CARSON CITY
State	:	MI
Zip	:	48811-0326
Country	:	US
Telephone Number	:	989-584-6801
Fax Number	:

Provider Business Practice Location Address
First Line	:	421 S BALDWIN ST
Second Line	:
City	:	GREENVILLE
State	:	MI
Zip	:	48838-2102
Country	:	US
Telephone Number	:	989-584-6801
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. KEVIN T OCONNOR
Credential	:	DO
Telephone Number	:	989-584-6801

Provider Enumeration Date	:	10/03/2007
Last Update Date	:	10/24/2007

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