Healthcare Provider Details

I. General information

NPI: 1386663623
Provider Name (Legal Business Name): RICHARD OBERG MSOM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3051 CAHILL MAIN
FITCHBURG WI
53711-7109
US

IV. Provider business mailing address

1265 JOHN Q HAMMONS DR
MADISON WI
53717-1941
US

V. Phone/Fax

Practice location:
  • Phone: 608-661-7200
  • Fax:
Mailing address:
  • Phone: 608-251-4156
  • Fax: 608-257-3842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number446
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: