Provider Demographics
NPI:1932197423
Name:OBERDOERSTER, MARK C (MD)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:C
Last Name:OBERDOERSTER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2200 GREEN RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105
Mailing Address - Country:US
Mailing Address - Phone:734-994-7446
Mailing Address - Fax:734-263-8590
Practice Address - Street 1:2200 GREEN RD
Practice Address - Street 2:SUITE B
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105
Practice Address - Country:US
Practice Address - Phone:734-994-7446
Practice Address - Fax:734-263-8590
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2021-06-14
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Provider Licenses
StateLicense IDTaxonomies
MI4301049857207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4302467Medicaid
MIB4552Medicare UPIN
MI0M13100 001Medicare PIN
MIB4552Medicare UPIN