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General NPI Number Information
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NPI Number | 1124512199
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Entity Type | Individual
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Provider Name | MARISSA ANN OBERSTADT DPM
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Gender | Female
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Dates
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Enumeration Date | 06/21/2018
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Last Update Date | 01/12/2023
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Provider Practice Location Address
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Address Line | 200 S EXECUTIVE DR STE 101
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City | BROOKFIELD
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State | WI
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Zip | 53005-4216
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Country | US
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Telephone | 888-964-6681
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Fax | 888-662-0859
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Provider Business Mailing Address
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Address Line | 209 OAK KNOLL CT
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City | HORTONVILLE
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State | WI
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Zip | 54944-9386
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Country | US
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Telephone | 920-851-4057
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 1186-25
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License Number State | WI
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