Provider Demographics
NPI:1801856141
Name:MESMER, OGUBAY TEKIE (MD)
Entity Type:Individual
Prefix:DR
First Name:OGUBAY
Middle Name:TEKIE
Last Name:MESMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:24 N SAINT JOSEPH AVE
Mailing Address - Street 2:STE F1
Mailing Address - City:NILES
Mailing Address - State:MI
Mailing Address - Zip Code:49120-2263
Mailing Address - Country:US
Mailing Address - Phone:269-684-6777
Mailing Address - Fax:269-683-5384
Practice Address - Street 1:61 N ST JOSEPH AVE
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:MI
Practice Address - Zip Code:49120
Practice Address - Country:US
Practice Address - Phone:269-684-6777
Practice Address - Fax:269-683-5384
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301079120207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4396875Medicaid
0601110531OtherBCBS
MIP00057496OtherRAILROAD MEDICARE PIN
0601110531OtherBCBS
MIN97240002Medicare PIN