Provider Demographics
NPI:1598873184
Name:OEFELEIN, MICHAEL GERARD (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:GERARD
Last Name:OEFELEIN
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 1:3941 SAN DIMAS ST STE 103A
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-5711
Mailing Address - Country:US
Mailing Address - Phone:661-520-5010
Mailing Address - Fax:661-520-5020
Practice Address - Street 1:3941 SAN DIMAS ST STE 103A
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-5711
Practice Address - Country:US
Practice Address - Phone:661-520-5010
Practice Address - Fax:661-520-5020
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2023-07-21
Deactivation Date:2019-04-12
Deactivation Code:
Reactivation Date:2019-04-24
Provider Licenses
StateLicense IDTaxonomies
CAG88466208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8393191Medicaid
CACJ815AOtherPTAN
CACJ815AMedicare PIN
CACJ815AOtherPTAN