Healthcare Provider Details

I. General information

NPI: 1376924902
Provider Name (Legal Business Name): DAVID OBERLIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2015
Last Update Date: 01/12/2024
Certification Date: 01/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 E PARIS AVE SE STE 100
GRAND RAPIDS MI
49546-6191
US

IV. Provider business mailing address

801 YORK ST
MANITOWOC WI
54220-4630
US

V. Phone/Fax

Practice location:
  • Phone: 616-678-2070
  • Fax: 616-940-4578
Mailing address:
  • Phone: 920-663-9008
  • Fax: 920-684-1439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number4301117195
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: