Provider Demographics
NPI:1831284470
Name:OSBOURNE, JEFFREY A (DPM)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:A
Last Name:OSBOURNE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3870 SOUTH 108TH STREET
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53228-1308
Mailing Address - Country:US
Mailing Address - Phone:414-327-2770
Mailing Address - Fax:414-327-0338
Practice Address - Street 1:3870 SOUTH 108TH STREET
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53228-1308
Practice Address - Country:US
Practice Address - Phone:414-327-2770
Practice Address - Fax:414-327-0338
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI681-025213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43219200Medicaid
WI43219200Medicaid
WI4260660001Medicare NSC