Healthcare Provider Details

I. General information

NPI: 1932165966
Provider Name (Legal Business Name): COBBLERS BENCH OF FRANKENMUTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

995 S MAIN ST
FRANKENMUTH MI
48734
US

IV. Provider business mailing address

995 S MAIN ST
FRANKENMUTH MI
48734
US

V. Phone/Fax

Practice location:
  • Phone: 989-652-2566
  • Fax: 989-652-4833
Mailing address:
  • Phone: 989-652-2566
  • Fax: 989-652-4833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN STEVEN OSTERMILLER
Title or Position: OWNER
Credential: CPED OST
Phone: 989-652-2566