Individual
KEVIN J OBRIEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
8433 HARCOURT RD STE 100, INDIANAPOLIS, IN 46260-2193
(317) 583-7600
Mailing address
1200 W WHITE RIVER BLVD, MUNCIE, IN 47303-4988
(877) 668-5621
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
10000356A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000375782
BCBS PIN
—
01
—
970010704
RAILROAD MEDICARE
—
Enumeration date
07/26/2006
Last updated
02/02/2021
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