Provider Demographics
NPI:1437321213
Name:O'BRIEN, COREY MICHAEL (DO)
Entity Type:Individual
Prefix:DR
First Name:COREY
Middle Name:MICHAEL
Last Name:O'BRIEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1200 E MICHIGAN AVE
Mailing Address - Street 2:SUITE 415
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-1800
Mailing Address - Country:US
Mailing Address - Phone:517-484-2760
Mailing Address - Fax:517-484-3050
Practice Address - Street 1:1200 E MICHIGAN AVE
Practice Address - Street 2:SUITE 415
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-1800
Practice Address - Country:US
Practice Address - Phone:517-484-2760
Practice Address - Fax:517-484-3050
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-01
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MICO018050207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI200000021794OtherPHP
MI1437321213Medicaid
MICO018050OtherBCBS/BCN