Healthcare Provider Details

I. General information

NPI: 1598443236
Provider Name (Legal Business Name): OBM HEALTHCARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2023
Last Update Date: 07/11/2023
Certification Date: 07/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 W MAIN ST
TROY OH
45373
US

IV. Provider business mailing address

39873 HIGHWAY 27 STE 418
DAVENPORT FL
33837-7802
US

V. Phone/Fax

Practice location:
  • Phone: 407-558-0426
  • Fax:
Mailing address:
  • Phone: 407-558-0426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. XAVIER ATENCIO
Title or Position: OWNER
Credential: MD
Phone: 407-558-0426