Provider Demographics
NPI:1164496238
Name:OBRIEN, MICHAEL SEAN (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:SEAN
Last Name:OBRIEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 890358
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73189-0358
Mailing Address - Country:US
Mailing Address - Phone:405-759-2663
Mailing Address - Fax:405-759-3827
Practice Address - Street 1:3110 SW 89TH ST
Practice Address - Street 2:SUITE 200C
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-7920
Practice Address - Country:US
Practice Address - Phone:405-759-2663
Practice Address - Fax:405-759-3827
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3481207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100102670AMedicaid
OKH25518Medicare UPIN
OK245427101Medicare ID - Type Unspecified
OK100102670AMedicaid