Provider Demographics
NPI:1164687646
Name:OSMON, DAVID CHARLES (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:CHARLES
Last Name:OSMON
Suffix:
Gender:M
Credentials:PHD
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Mailing Address - Street 1:5723 N CRESTWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-4309
Mailing Address - Country:US
Mailing Address - Phone:414-573-5138
Mailing Address - Fax:414-229-5219
Practice Address - Street 1:2025 E NEWPORT AVE
Practice Address - Street 2:SACRED HEART REHABILITATION INSTITUTE
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211
Practice Address - Country:US
Practice Address - Phone:414-298-6700
Practice Address - Fax:414-229-5219
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-23
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI836103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist