# KEVIN J OBRIEN DPM INC

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

## Provider details

- **NPI number:** 1558550533
- **Authorized official:** KEVIN JOHN OBRIEN DPM (OWNER)
- **Authorized official phone:** (928) 854-4307

## Contact information

- **Practice address:** 1731 MESQUITE AVE STE 4, LAKE HAVASU CITY, AZ 86403-5653
- **Practice address phone:** (928) 854-4307
- **Practice address fax:** (928) 854-4339
- **Mailing address:** PO BOX 3028, LAKE HAVASU CITY, AZ 86405
- **Mailing address phone:** (928) 854-4307
- **Mailing address fax:** (928) 854-4339

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | 0541 | AZ | Yes |

## Other

- **Enumeration date:** 10/16/2007
- **Last updated:** 03/07/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 572124 | — | AZ |
| 01 | — | DC2459 | RAILROAD MEDICARE | AZ |