Provider Demographics
NPI:1235188525
Name:OBRIEN, MARK S (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:S
Last Name:OBRIEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4070 LAKE DR SE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-8294
Mailing Address - Country:US
Mailing Address - Phone:616-774-8200
Mailing Address - Fax:616-774-0304
Practice Address - Street 1:4070 LAKE DR SE
Practice Address - Street 2:SUITE 201
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-8294
Practice Address - Country:US
Practice Address - Phone:616-774-8200
Practice Address - Fax:616-774-0304
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-06
Last Update Date:2009-11-16
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Provider Licenses
StateLicense IDTaxonomies
MIMO048187207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine