Provider Demographics
NPI:1417577024
Name:O'BRIEN, MATTHEW CHRISTOPHER (DO)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:CHRISTOPHER
Last Name:O'BRIEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 22ND AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WI
Mailing Address - Zip Code:53566-1569
Mailing Address - Country:US
Mailing Address - Phone:630-639-6360
Mailing Address - Fax:
Practice Address - Street 1:4201 SAINT ANTOINE ST STE 9C
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2153
Practice Address - Country:US
Practice Address - Phone:313-577-5009
Practice Address - Fax:313-577-5310
Is Sole Proprietor?:No
Enumeration Date:2020-04-23
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI81821208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery