Provider Demographics
NPI:1538456215
Name:STEVE OBEREMOK M.D. INC
Entity Type:Organization
Organization Name:STEVE OBEREMOK M.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:OBEREMOK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-658-9461
Mailing Address - Street 1:28780 SINGLE OAK DR
Mailing Address - Street 2:SUITE 160
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-3625
Mailing Address - Country:US
Mailing Address - Phone:951-658-9461
Mailing Address - Fax:
Practice Address - Street 1:28780 SINGLE OAK DR
Practice Address - Street 2:SUITE 160
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-3625
Practice Address - Country:US
Practice Address - Phone:951-658-9461
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-01
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA86584207N00000X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1598709867OtherINDIVIDUAL NPI
1598709867OtherINDIVIDUAL NPI
100673Medicare UPIN