Healthcare Provider Details

I. General information

NPI: 1821662594
Provider Name (Legal Business Name): ANDREW OBRITSCH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2021
Last Update Date: 10/25/2024
Certification Date: 10/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 4TH ST SW STE 340
MASON CITY IA
50401-2856
US

IV. Provider business mailing address

600 1ST ST NW STE 101
MASON CITY IA
50401-2932
US

V. Phone/Fax

Practice location:
  • Phone: 641-428-7766
  • Fax: 641-428-7788
Mailing address:
  • Phone: 641-428-7766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number21309
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: