Provider Demographics
NPI:1083639397
Name:O'BRIEN, PATRICK J (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:J
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 1:8161 33RD AVE S UNIT 1702W
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4551
Mailing Address - Country:US
Mailing Address - Phone:952-303-2452
Mailing Address - Fax:
Practice Address - Street 1:8161 33RD AVE S UNIT 1702W
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55425-4551
Practice Address - Country:US
Practice Address - Phone:952-303-2452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN324172085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN118457100Medicaid
MN16-06215OtherMEDICA
MN06S62OBOtherBCBS PIN #
MN06S62OBOtherBCBS PIN #
MN16-06215OtherMEDICA