Provider Demographics
NPI:1134131733
Name:O'BRIEN, KEVIN P (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:P
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 1:6801 S YOSEMITE ST STE 180
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-1411
Mailing Address - Country:US
Mailing Address - Phone:303-773-9000
Mailing Address - Fax:303-770-1449
Practice Address - Street 1:3260 E 104TH AVE
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80233-4406
Practice Address - Country:US
Practice Address - Phone:720-929-8300
Practice Address - Fax:720-929-8444
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO42142207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0873194Medicaid
CO62777076Medicaid
CO26003329908OtherPACIFICARE
CO1057406OtherUNITED HEALTHCARE
COOBO68158OtherBLUE CROSS BLUE SHIELD
CO0873194Medicaid
COC808945Medicare PIN