Provider Demographics
NPI:1487091989
Name:O'BRIEN, TREVOR K (MD,)
Entity type:Individual
Prefix:
First Name:TREVOR
Middle Name:K
Last Name:O'BRIEN
Suffix:
Gender:M
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4244 CURTIS RD
Mailing Address - Street 2:
Mailing Address - City:BIRCH RUN
Mailing Address - State:MI
Mailing Address - Zip Code:48415-9016
Mailing Address - Country:US
Mailing Address - Phone:989-798-8356
Mailing Address - Fax:
Practice Address - Street 1:4170 CEDAR BLUFF DR
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-7627
Practice Address - Country:US
Practice Address - Phone:231-487-2230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-24
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43011169662086S0122X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery