MEDICARE: DR. MICHAEL JAY OPPERMAN MD, PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	4301506926	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11019971A	OTHER	IN	POSTGRADUATE TRAINING PERMIT

General Provider Information

NPI Number	:	1427554310
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL JAY OPPERMAN MD, PHD

Provider Business Mailing Address
First Line	:	1105 SIXTH ST
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-2386
Country	:	US
Telephone Number	:	231-935-6380
Fax Number	:	231-935-6920

Provider Business Practice Location Address
First Line	:	1105 SIXTH ST
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-2386
Country	:	US
Telephone Number	:	231-935-6380
Fax Number	:	231-935-6920

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/01/2018
Last Update Date	:	01/27/2026

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