Provider Demographics
NPI:1740280619
Name:HOSBACH, EDWARD E II (DO)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:E
Last Name:HOSBACH
Suffix:II
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 UNION CITY RD
Mailing Address - Street 2:P.O. BOX 635
Mailing Address - City:FT RECOVERY
Mailing Address - State:OH
Mailing Address - Zip Code:45846-9315
Mailing Address - Country:US
Mailing Address - Phone:419-375-4144
Mailing Address - Fax:419-375-4361
Practice Address - Street 1:1830 UNION CITY RD
Practice Address - Street 2:
Practice Address - City:FT RECOVERY
Practice Address - State:OH
Practice Address - Zip Code:45846-9315
Practice Address - Country:US
Practice Address - Phone:419-375-4144
Practice Address - Fax:419-375-4361
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34 004555207Q00000X
IN02002043207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9282991OtherMEDICARE GROUP
OH0234455OtherMEDICAID GROUP
OH0752412Medicaid
OH9282991OtherMEDICARE GROUP
OH0752412Medicaid
OH9282992Medicare PIN
OH0234455OtherMEDICAID GROUP