Provider Demographics
NPI:1689745556
Name:OSBORNE, MICHAEL DEWITT
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DEWITT
Last Name:OSBORNE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14634 ELKIN HIGHWAY 268
Mailing Address - Street 2:
Mailing Address - City:RONDA
Mailing Address - State:NC
Mailing Address - Zip Code:28670-9179
Mailing Address - Country:US
Mailing Address - Phone:336-835-2776
Mailing Address - Fax:336-526-8329
Practice Address - Street 1:14634 ELKIN HIGHWAY 268
Practice Address - Street 2:
Practice Address - City:RONDA
Practice Address - State:NC
Practice Address - Zip Code:28670-9179
Practice Address - Country:US
Practice Address - Phone:336-835-2776
Practice Address - Fax:336-526-8329
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC00702332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC4564040001Medicare NSC