MEDICARE: NEAL EDWARD OBERMYER M.D.

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	207YX0602X	Otolaryngic Allergy Physician	NO054737	MI
2	207Y00000X	Otolaryngology Physician	NO054737	MI
3	207YX0007X	Plastic Surgery within the Head & Neck (Otolaryngology) Physician	NO054737	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	F77961	OTHER	MI	HAP
2	127760	OTHER	MI	CARE CHOICES
3	1912162005	OTHER	MI	CIGNA
4	040015414	OTHER	MI	RRMCR
5	0407411191	OTHER	MI	BCBS OF MICHIGAN
6	4474473	OTHER	MI	AETNA

General Provider Information

NPI Number	:	1518947977
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NEAL EDWARD OBERMYER M.D.

Provider Business Mailing Address
First Line	:	3838 SPARTAN DRIVE
Second Line	:
City	:	FORT GRATIOT
State	:	MI
Zip	:	48059
Country	:	US
Telephone Number	:	810-434-6542
Fax Number	:	810-982-0716

Provider Business Practice Location Address
First Line	:	3838 SPARTAN DRIVE
Second Line	:
City	:	FORT GRATIOT
State	:	MI
Zip	:	48059
Country	:	US
Telephone Number	:	810-434-6542
Fax Number	:	810-982-0716

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

Provider Enumeration Date	:	01/20/2006
Last Update Date	:	03/12/2026

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Directions to “ NEAL EDWARD OBERMYER M.D.” Practice Location

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