Provider Demographics
NPI:1699737619
Name:OBERMEIER, MICHAEL CHARLES (ATC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:CHARLES
Last Name:OBERMEIER
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1070 GRANDVIEW CT NE
Mailing Address - Street 2:#302
Mailing Address - City:COLUMBIA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55421-2384
Mailing Address - Country:US
Mailing Address - Phone:612-799-4664
Mailing Address - Fax:
Practice Address - Street 1:8100 NORTHLAND DR
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55431-4800
Practice Address - Country:US
Practice Address - Phone:952-806-5380
Practice Address - Fax:952-806-5469
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN22832255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer