Provider Demographics
NPI:1407920440
Name:OSETINSKY, MICHAEL VENEDICT (MD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:VENEDICT
Last Name:OSETINSKY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1724 WEST MARINE VIEW DRIVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-2088
Mailing Address - Country:US
Mailing Address - Phone:425-252-2333
Mailing Address - Fax:425-252-3359
Practice Address - Street 1:1724 WEST MARINE VIEW DRIVE
Practice Address - Street 2:SUITE 130
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-2088
Practice Address - Country:US
Practice Address - Phone:425-252-2333
Practice Address - Fax:425-252-3359
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WA207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1110873Medicaid
B25299Medicare UPIN
WAGAB15219Medicare ID - Type Unspecified