Healthcare Provider Details

I. General information

NPI: 1083762371
Provider Name (Legal Business Name): MICHAEL PAUL OBERDOERSTER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 VICTORY PKWY
CINCINNATI OH
45206-1711
US

IV. Provider business mailing address

3630 KENDALL AVE
CINCINNATI OH
45208-1111
US

V. Phone/Fax

Practice location:
  • Phone: 513-872-5863
  • Fax: 513-861-1718
Mailing address:
  • Phone: 513-871-3666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35053107
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number35053107
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: