# MICHAEL OBRIEN MD PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1558517102
- **Authorized official:** JEREMY EVANS (BILLING SUPERVISOR)
- **Authorized official phone:** (208) 367-2802

## Contact information

- **Practice address:** 901 N CURTIS RD, SUITE 101, BOISE, ID 83706-1338
- **Practice address phone:** (208) 367-2802
- **Practice address fax:** (208) 375-8755
- **Mailing address:** 901 N CURTIS RD, SUITE 101, BOISE, ID 83706-1338
- **Mailing address phone:** (208) 367-2802
- **Mailing address fax:** (208) 375-8755

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 174400000X | Specialist | M2977 | ID | Yes |

## Other

- **Enumeration date:** 08/14/2008
- **Last updated:** 08/19/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 002425500 | — | ID |