Provider Demographics
NPI:1952368896
Name:OBRIEN, SEAN P (MD)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:P
Last Name:OBRIEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1535 GULL RD
Mailing Address - Street 2:SUITE 020
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49048-1650
Mailing Address - Country:US
Mailing Address - Phone:269-381-4577
Mailing Address - Fax:269-381-6409
Practice Address - Street 1:1535 GULL RD
Practice Address - Street 2:SUITE 020
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49048-1650
Practice Address - Country:US
Practice Address - Phone:269-381-4577
Practice Address - Fax:269-381-6409
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MISO059838208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4130866Medicaid
MI4130866Medicaid
MIOM84600004Medicare ID - Type Unspecified