1013935071 NPI number — LUIS OSTERBERGER M.D.

Table of content: (NPI 1457515892)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013935071 NPI number — LUIS OSTERBERGER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OSTERBERGER
Provider First Name:
LUIS
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013935071
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/21/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
27177 LAHSER RD
Provider Second Line Business Mailing Address:
SUITE103
Provider Business Mailing Address City Name:
SOUTHFIELD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48034-4714
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-357-1360
Provider Business Mailing Address Fax Number:
248-357-2610

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
27177 LAHSER RD
Provider Second Line Business Practice Location Address:
SUITE103
Provider Business Practice Location Address City Name:
SOUTHFIELD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48034-4714
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-357-1360
Provider Business Practice Location Address Fax Number:
248-357-2610
Provider Enumeration Date:
07/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  4301035871 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1389877 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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