Provider Demographics
NPI:1124512199
Name:OBERSTADT, MARISSA ANN (DPM)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:ANN
Last Name:OBERSTADT
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:MARISSA
Other - Middle Name:ANN
Other - Last Name:HOELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:209 OAK KNOLL CT
Mailing Address - Street 2:
Mailing Address - City:HORTONVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54944-9386
Mailing Address - Country:US
Mailing Address - Phone:920-851-4057
Mailing Address - Fax:
Practice Address - Street 1:200 S EXECUTIVE DR STE 101
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-4216
Practice Address - Country:US
Practice Address - Phone:888-964-6681
Practice Address - Fax:888-662-0859
Is Sole Proprietor?:No
Enumeration Date:2018-06-21
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1186-25213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery