Provider Demographics
NPI:1104265933
Name:O'BRIEN, SHANLEY MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:SHANLEY
Middle Name:MARIE
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 PARK FOREST DR STE 200
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-7306
Mailing Address - Country:US
Mailing Address - Phone:231-600-7466
Mailing Address - Fax:913-588-8182
Practice Address - Street 1:4100 PARK FOREST DR STE 200
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-7306
Practice Address - Country:US
Practice Address - Phone:231-600-7466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-14
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301500409207RR0500X
KS9408209207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine