Healthcare Provider Details

I. General information

NPI: 1104326206
Provider Name (Legal Business Name): PAULA OSTERHOUT MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2018
Last Update Date: 08/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3070 N 51ST ST STE P309
MILWAUKEE WI
53210
US

IV. Provider business mailing address

3070 N 51ST ST STE P309
MILWAUKEE WI
53210-1645
US

V. Phone/Fax

Practice location:
  • Phone: 414-447-2674
  • Fax: 414-447-1070
Mailing address:
  • Phone:
  • Fax: 414-477-1070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: PAULA BANSER OSTERHOUT
Title or Position: PRESIDENT
Credential:
Phone: 708-945-2082