Kevin J Obrien DPM Inc

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

License

0541 Issued in AZ

Legal business name

KEVIN J OBRIEN DPM INC

Practice address

1731 Mesquite Ave Ste 4
Lake Havasu City, AZ 86403-5653

Phone

(928) 854-4307

Fax

(928) 854-4339

NPI assigned

Oct 16, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kevin John Obrien, DPMNPI 1568545481

Title

Owner

Phone

(928) 854-4307

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in AZ2 enrollments

Enrollment records 2

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kevin John O Brien, DPM

  • Foot & Ankle Surgery Podiatrist
  • Kingman, AZ
  • NPI 1568545481
  Medicare reassignment NPD Authorized official
• Ronald Bernard Killian, DPM

  • Foot & Ankle Surgery Podiatrist
  • Lake Havasu City, AZ
  • NPI 1205813565
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1192492800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1558550533",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3028",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "86405",
            "telephone_number": "928-854-4307",
            "fax_number": "928-854-4339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1731 MESQUITE AVE STE 4",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864035653",
            "telephone_number": "928-854-4307",
            "fax_number": "928-854-4339"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEVIN J OBRIEN DPM INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-16",
        "last_updated": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "OBRIEN",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "928-854-4307",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "AZ",
            "license": "0541",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DC2459",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "572124",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tod Dempsey Keam, O.T.R.
• Jennifer Keele, LMT
• Stephanie Lynn Kent, OCCUPATIONAL THERAPI
• Kevin Eugene Keough
• Ezekiel Keereng Kesitilwe, PHARMD
• Ronald Bernard Killian, DPM
• Chang Kim, D.M.D.
• Cheryl M Kingsbury, MS, OTR/L
• Deborah Ann Kinzer, D.D.S.
• Kaleigh-Jo Taylor Kirby, PA

• Foot & Ankle Surgery Podiatrist in Lake Havasu City, AZ
• Providers in Lake Havasu City, AZ by specialty
• Foot & Ankle Surgery Podiatrist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.