Provider Demographics
NPI:1124024625
Name:O'BRIEN, KEITH OSMOND (MD)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:OSMOND
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:COMMUNITY HOSPITALISTS, LLC
Mailing Address - Street 2:PO BOX 39413
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44139
Mailing Address - Country:US
Mailing Address - Phone:440-523-5023
Mailing Address - Fax:440-523-5029
Practice Address - Street 1:SOUTHWEST GENERAL HEALTH CENTER
Practice Address - Street 2:18697 BAGLEY ROAD
Practice Address - City:MIDDLEBURG HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130
Practice Address - Country:US
Practice Address - Phone:440-816-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-08-2150-0207Q00000X
FLME101224207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2386850Medicaid
OH2386850Medicaid
H79730Medicare UPIN