Provider Demographics
NPI:1396943015
Name:MARK T. O'BRIEN, D.O., P.C.
Entity type:Organization
Organization Name:MARK T. O'BRIEN, D.O., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:T
Authorized Official - Last Name:O'BRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:810-329-4660
Mailing Address - Street 1:4150 RIVER RD
Mailing Address - Street 2:SUITE F2
Mailing Address - City:EAST CHINA
Mailing Address - State:MI
Mailing Address - Zip Code:48054-2915
Mailing Address - Country:US
Mailing Address - Phone:810-329-4660
Mailing Address - Fax:810-329-4699
Practice Address - Street 1:4150 RIVER RD
Practice Address - Street 2:SUITE F2
Practice Address - City:EAST CHINA
Practice Address - State:MI
Practice Address - Zip Code:48054-2915
Practice Address - Country:US
Practice Address - Phone:810-329-4660
Practice Address - Fax:810-329-4699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101009744207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty