Provider Demographics
NPI:1164487740
Name:OSBORN, L JOHN (DO)
Entity Type:Individual
Prefix:DR
First Name:L
Middle Name:JOHN
Last Name:OSBORN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:406 E ELM ST
Mailing Address - Street 2:PO BOX 879
Mailing Address - City:CARSON CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48811
Mailing Address - Country:US
Mailing Address - Phone:989-584-3971
Mailing Address - Fax:989-584-3729
Practice Address - Street 1:11017 WEST THIRD ST
Practice Address - Street 2:
Practice Address - City:FOWLER
Practice Address - State:MI
Practice Address - Zip Code:48835
Practice Address - Country:US
Practice Address - Phone:989-593-2525
Practice Address - Fax:989-593-3385
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101006593207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1480607Medicaid
MI1480607Medicaid
L0006593Medicare ID - Type Unspecified