Healthcare Provider Details

I. General information

NPI: 1487391702
Provider Name (Legal Business Name): MITCHELL TEAGUE OBERHELMAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2022
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 HOUSE AVE STE 400
CHEYENNE WY
82001-3180
US

IV. Provider business mailing address

2301 HOUSE AVE STE 400
CHEYENNE WY
82001-3180
US

V. Phone/Fax

Practice location:
  • Phone: 307-634-5216
  • Fax: 307-638-6675
Mailing address:
  • Phone: 307-634-5216
  • Fax: 307-638-6675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number20156A
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: