Provider Demographics
NPI:1871814293
Name:OSTERHOUT, PAULA BANSER (MD)
Entity type:Individual
Prefix:DR
First Name:PAULA
Middle Name:BANSER
Last Name:OSTERHOUT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:17345 CIVIC DR STE 1327
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-5070
Mailing Address - Country:US
Mailing Address - Phone:414-447-7330
Mailing Address - Fax:414-447-1070
Practice Address - Street 1:17345 CIVIC DR STE 1327
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53045-5070
Practice Address - Country:US
Practice Address - Phone:414-447-7330
Practice Address - Fax:414-447-1070
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-21
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI65051-202080N0001X
IL036.1321012080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine