Healthcare Provider Details

I. General information

NPI: 1407862485
Provider Name (Legal Business Name): JOHN MICHAEL OBERLIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1465 S GRAND BLVD RM 3728
SAINT LOUIS MO
63104-1003
US

IV. Provider business mailing address

144 HIGHGROVE LN
CHESTERFIELD MO
63005-7128
US

V. Phone/Fax

Practice location:
  • Phone: 314-577-5648
  • Fax: 314-268-6448
Mailing address:
  • Phone: 210-383-8046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2005021465
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number2005021465
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: