MEDICARE: DR. MICHAEL K OBENG MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208200000X	Plastic Surgery Physician	A107087	CA
2	2082S0105X	Surgery of the Hand (Plastic Surgery) Physician	35.088914	OH

General Provider Information

NPI Number	:	1407811854
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL K OBENG MD

Provider Business Mailing Address
First Line	:	435 N ROXBURY DRIVE SUITE 205
Second Line	:	MIKO PLASTIC SURGERY
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90210
Country	:	US
Telephone Number	:	310-275-2705
Fax Number	:	310-275-2701

Provider Business Practice Location Address
First Line	:	435 N ROXBURY DR STE 205
Second Line	:	MIKO PLASTIC SURGERY
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90210-5004
Country	:	US
Telephone Number	:	310-275-2705
Fax Number	:	310-275-2701

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/19/2006
Last Update Date	:	01/24/2014

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