MEDICARE: ANDREW OBERLIN PA-C

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	363AM0700X	Medical Physician Assistant	1426 TEMP	MN
2	363AM0700X	Medical Physician Assistant	10755	MN
3	363A00000X	Physician Assistant	5601007017	MI

General Provider Information

NPI Number	:	1821309477
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW OBERLIN PA-C

Provider Business Mailing Address
First Line	:	1400 W ICE LAKE RD
Second Line	:
City	:	IRON RIVER
State	:	MI
Zip	:	49935-9526
Country	:	US
Telephone Number	:	906-265-6121
Fax Number	:

Provider Business Practice Location Address
First Line	:	1300 W ICE LAKE RD
Second Line	:
City	:	IRON RIVER
State	:	MI
Zip	:	49935-8507
Country	:	US
Telephone Number	:	906-265-9189
Fax Number	:

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

Provider Enumeration Date	:	06/29/2010
Last Update Date	:	10/21/2015

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Directions to “ ANDREW OBERLIN PA-C” Practice Location

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