Basic Information
| Provider Information | |||||||||
| NPI: | 1952693079 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | O'REILLY | ||||||||
| FirstName: | KEVIN | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3621 SOUTH STATE STREET | ||||||||
| Address2: | 700 KMS PLACE | ||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7349362047 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1500 EAST MEDICAL CENTER DRIVE | ||||||||
| Address2: | 3RD FLOOR TAUBMAN CENTER RECP B | ||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481095352 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7349365582 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/08/2011 | ||||||||
| LastUpdateDate: | 12/17/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | 275948 | NY | N | Allopathic & Osteopathic Physicians | Hospitalist | 390200000X | 63116 | NY | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207R00000X | 5101022492 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.