Provider Demographics
NPI:1437114394
Name:O'BRIEN, ERIN KATHLEEN (MD)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:KATHLEEN
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:ERIN
Other - Middle Name:KATHLEEN
Other - Last Name:KELLAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:301 N RANDALL RD
Mailing Address - Street 2:
Mailing Address - City:LAKE IN THE HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60156-5961
Mailing Address - Country:US
Mailing Address - Phone:847-658-6065
Mailing Address - Fax:847-658-6136
Practice Address - Street 1:301 N RANDALL RD
Practice Address - Street 2:
Practice Address - City:LAKE IN THE HILLS
Practice Address - State:IL
Practice Address - Zip Code:60156-5961
Practice Address - Country:US
Practice Address - Phone:847-658-6065
Practice Address - Fax:847-658-6136
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036108387208000000X
IL036-108-387208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics