Provider Demographics
NPI:1518947977
Name:OBERMYER, NEAL EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:NEAL
Middle Name:EDWARD
Last Name:OBERMYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1522 PINE GROVE AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-3382
Mailing Address - Country:US
Mailing Address - Phone:810-982-3277
Mailing Address - Fax:810-982-0716
Practice Address - Street 1:1522 PINE GROVE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-3382
Practice Address - Country:US
Practice Address - Phone:810-982-3277
Practice Address - Fax:810-982-0716
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MINO054737207Y00000X, 207YX0007X, 207YX0602X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
No207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic Allergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIF77961OtherHAP
MI127760OtherCARE CHOICES
MI1912162005OtherCIGNA
MI040015414OtherRRMCR
MI0407411191OtherBCBS OF MICHIGAN
MI4474473OtherAETNA
MIOM60020003Medicare PIN
MI0407411191OtherBCBS OF MICHIGAN