Provider Demographics
NPI:1447639612
Name:O'BRIEN, MICHAEL JEREMY (CASE MANAGER)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JEREMY
Last Name:O'BRIEN
Suffix:
Gender:M
Credentials:CASE MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 N SHERMAN ST
Mailing Address - Street 2:APT 210
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80203-2815
Mailing Address - Country:US
Mailing Address - Phone:440-289-5950
Mailing Address - Fax:
Practice Address - Street 1:4455 E 12TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-2415
Practice Address - Country:US
Practice Address - Phone:303-504-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-21
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator