Provider Demographics
NPI:1811162928
Name:HANNA OBERTYNSKI M D P C
Entity type:Organization
Organization Name:HANNA OBERTYNSKI M D P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:HANNA
Authorized Official - Middle Name:J
Authorized Official - Last Name:OBERTYNSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-524-4000
Mailing Address - Street 1:2891 E MAPLE RD
Mailing Address - Street 2:STE#200
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-6106
Mailing Address - Country:US
Mailing Address - Phone:248-524-4000
Mailing Address - Fax:248-524-0077
Practice Address - Street 1:2891 E MAPLE RD
Practice Address - Street 2:STE#200
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-6106
Practice Address - Country:US
Practice Address - Phone:248-524-4000
Practice Address - Fax:248-524-0077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301030536174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
180F387820OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
180F387820OtherMEDICARE ADVANTAGE PFFS
180F387820OtherBLUE CARE NETWORK
180F387820OtherBCN ADVANTAGE
125115OtherCARE CHOICE HMO
125115OtherCARE CHOICE PPO
180F387820OtherMEDICARE PLUS BLUE PPO
A73929OtherHEALTH ALLIANCE PLAN
181045143OtherMEDICARE RAILROAD UHC
104160OtherGREAT LAKES HEALTH PLAN
125115OtherCARE CHOICE PPO
180F387820OtherMEDICARE ADVANTAGE PFFS