MEDICARE: DR. PAULA BANSER OSTERHOUT 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	2080N0001X	Neonatal-Perinatal Medicine Physician	65051-20	WI
2	2080N0001X	Neonatal-Perinatal Medicine Physician	036.132101	IL

General Provider Information

NPI Number	:	1871814293
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAULA BANSER OSTERHOUT M.D.

Provider Business Mailing Address
First Line	:	17345 CIVIC DR STE 1327
Second Line	:
City	:	BROOKFIELD
State	:	WI
Zip	:	53045-5070
Country	:	US
Telephone Number	:	414-447-7330
Fax Number	:	414-447-1070

Provider Business Practice Location Address
First Line	:	17345 CIVIC DR STE 1327
Second Line	:
City	:	BROOKFIELD
State	:	WI
Zip	:	53045-5070
Country	:	US
Telephone Number	:	414-447-7330
Fax Number	:	414-447-1070

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

Provider Enumeration Date	:	06/21/2010
Last Update Date	:	08/30/2024

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