Provider Demographics
NPI:1104326206
Name:PAULA OSTERHOUT MD, LLC
Entity type:Organization
Organization Name:PAULA OSTERHOUT MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:BANSER
Authorized Official - Last Name:OSTERHOUT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-945-2082
Mailing Address - Street 1:3070 N 51ST ST STE P309
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53210-1645
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:414-477-1070
Practice Address - Street 1:3070 N 51ST ST STE P309
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53210
Practice Address - Country:US
Practice Address - Phone:414-447-2674
Practice Address - Fax:414-447-1070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-15
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal MedicineGroup - Single Specialty