Provider Demographics
NPI:1821165135
Name:O'BRIAN, DAVID WILLIAM (DPM)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:WILLIAM
Last Name:O'BRIAN
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 1:705 WARRENVILLE RD STE B
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60189-6379
Mailing Address - Country:US
Mailing Address - Phone:630-668-8277
Mailing Address - Fax:630-246-3398
Practice Address - Street 1:31 S SUTTON RD
Practice Address - Street 2:
Practice Address - City:STREAMWOOD
Practice Address - State:IL
Practice Address - Zip Code:60107-3367
Practice Address - Country:US
Practice Address - Phone:630-830-2155
Practice Address - Fax:630-246-3398
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016-003127213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL480022179OtherRAILROAD MEDICARE
IL22900-99OtherBLUE CROSS & BLUE SHIELD
IL480022179OtherRAILROAD MEDICARE
ILL58204Medicare PIN
ILL58204Medicare PIN