Provider Demographics
NPI:1396743670
Name:OCONNOR, KEVIN A (MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:A
Last Name:OCONNOR
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6545 FRANCE AVE S
Mailing Address - Street 2:#671
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2131
Mailing Address - Country:US
Mailing Address - Phone:952-829-1853
Mailing Address - Fax:952-922-5047
Practice Address - Street 1:6545 FRANCE AVE S
Practice Address - Street 2:#671
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2131
Practice Address - Country:US
Practice Address - Phone:952-829-1853
Practice Address - Fax:952-922-5047
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2009-05-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN340552084P0800X
CAG484952084P0800X
IA248352084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN2156268OtherCIGNA BEHAVIORAL HEALTH
MN962321000211OtherPREFERRED ONE COMM HEALTH
MN103013OtherU CARE
MN1500271OtherMEDICA
104891600OtherDEPARTMENT OF LABOR
MN962321000211OtherPREFERRED ONE
MN962321000211OtherPREFERRED ON ADMIN SERVIC
MN19118OtherHEALTH PARTNER
MN5K3920COtherBC
MN986303600Medicaid
MN103013OtherU CARE
MN962321000211OtherPREFERRED ON ADMIN SERVIC