Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 4301074191 | MI |
N | 207WX0107X | Retina Specialist | 4301074191 | MI |
NPI | 1003976416 |
---|---|
Provider Name | Michael D Ober |
First Address | Southfield, MI 48034 |
Second Address | Southfield, MI 48034 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2006 |
Last Update Date | 09/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
180H262240 | BLUE CROSS-BLUE CROSS (01) | |
478697910 | (05) | MI |
H99762 | (02) | |
MO074191 | CHAMPUS-CHAMPUS (01) | |
MO074191 | COMMERCIAL-COMMERCIAL NUMBER (01) |