MEDICARE: DR. MICHAEL E. OBENSHAIN MD

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	207R00000X	Internal Medicine Physician	036839	GA

General Provider Information

NPI Number	:	1528153723
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL E. OBENSHAIN MD

Provider Business Mailing Address
First Line	:	PO BOX 102321
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30368-2321
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4000 SHAKERAG HL
Second Line	:
City	:	PEACHTREE CITY
State	:	GA
Zip	:	30269-4047
Country	:	US
Telephone Number	:	770-486-7100
Fax Number	:

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

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	04/01/2011

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