1699737619 NPI number — MR. MICHAEL CHARLES OBERMEIER ATC

Table of content: MR. MICHAEL CHARLES OBERMEIER ATC (NPI 1699737619)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699737619 NPI number — MR. MICHAEL CHARLES OBERMEIER ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OBERMEIER
Provider First Name:
MICHAEL
Provider Middle Name:
CHARLES
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
ATC
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:
1699737619
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/18/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1070 GRANDVIEW CT NE
Provider Second Line Business Mailing Address:
#302
Provider Business Mailing Address City Name:
COLUMBIA HEIGHTS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55421-2384
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-799-4664
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8100 NORTHLAND DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55431-4800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-806-5380
Provider Business Practice Location Address Fax Number:
952-806-5469
Provider Enumeration Date:
04/05/2006

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: 2255A2300X , with the licence number:  2283 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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