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General NPI Number Information
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NPI Number | 1649392549
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Entity Type | Individual
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Provider Name | PADRAIC RORY OBMA M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 12/13/2019
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Provider Practice Location Address
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Address Line | 1726 SHAWANO AVE
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City | GREEN BAY
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State | WI
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Zip | 54303-3216
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Country | US
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Telephone | 920-496-4700
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Fax |
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Provider Business Mailing Address
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Address Line | 4762 CINNAMON PL
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City | INDIANAPOLIS
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State | IN
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Zip | 46237-3681
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Country | US
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Telephone | 317-437-8365
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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 | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | MD.28068
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | 51923-20
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License Number State | WI
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