Provider Demographics
NPI:1467565911
Name:OSSWALD, MICHAEL BERNHARD (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:BERNHARD
Last Name:OSSWALD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8814 SHADY VLY
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78254-5558
Mailing Address - Country:US
Mailing Address - Phone:210-520-9729
Mailing Address - Fax:210-292-7317
Practice Address - Street 1:2200 BERGQUIST DR
Practice Address - Street 2:759 MDOS/MMIH STE 1
Practice Address - City:LACKLAND A F B
Practice Address - State:TX
Practice Address - Zip Code:78236-9907
Practice Address - Country:US
Practice Address - Phone:210-292-5688
Practice Address - Fax:210-292-7317
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-054741-L207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology