Provider Demographics
NPI:1033188545
Name:O'BRIEN, THOMAS KIRK (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:KIRK
Last Name:O'BRIEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6276 JACKSON RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-9579
Mailing Address - Country:US
Mailing Address - Phone:734-663-4490
Mailing Address - Fax:
Practice Address - Street 1:6276 JACKSON RD
Practice Address - Street 2:SUITE B
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-9579
Practice Address - Country:US
Practice Address - Phone:734-663-4490
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI406214207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2871468Medicaid
MI2871468Medicaid
MIF07607Medicare UPIN