Basic Information
Provider Information
NPI: 1114140605
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: O'BROIN
FirstName: SEAMUS
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3621 S STATE ST
Address2: 700 KMS PLACE
City: ANN ARBOR
State: MI
PostalCode: 48108
CountryCode: US
TelephoneNumber: 7349362047
FaxNumber:  
Practice Location
Address1: 1051 NORTH CANTON CENTER RD
Address2:  
City: CANTON
State: MI
PostalCode: 481875097
CountryCode: US
TelephoneNumber: 7348445400
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/11/2007
LastUpdateDate: 12/30/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207V00000X4301081975MIY Allopathic & Osteopathic PhysiciansObstetrics & Gynecology 
207VX0000X4301081975MIN Allopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics

No ID Information.


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