Healthcare Provider Details

I. General information

NPI: 1104563329
Provider Name (Legal Business Name): RENEE OBROCK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2022
Last Update Date: 10/30/2023
Certification Date: 10/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5726 SOUTHWYCK BLVD STE 115
TOLEDO OH
43614-1510
US

IV. Provider business mailing address

5726 SOUTHWYCK BLVD STE 115
TOLEDO OH
43614-1510
US

V. Phone/Fax

Practice location:
  • Phone: 419-708-0441
  • Fax:
Mailing address:
  • Phone: 419-708-0441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: