Provider Demographics
NPI:1295846152
Name:O'SHEA, MICHAEL KEVIN (DPM)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:KEVIN
Last Name:O'SHEA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1201 S HACIENDA BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HACIENDA HTS
Mailing Address - State:CA
Mailing Address - Zip Code:91745-2200
Mailing Address - Country:US
Mailing Address - Phone:626-961-1882
Mailing Address - Fax:626-968-7599
Practice Address - Street 1:1201 S HACIENDA BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:HACIENDA HTS
Practice Address - State:CA
Practice Address - Zip Code:91745-2200
Practice Address - Country:US
Practice Address - Phone:626-961-1882
Practice Address - Fax:626-968-7599
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAE2624213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT19213Medicare UPIN
CAE2624Medicare PIN