Provider Demographics
NPI:1225875032
Name:OSBORN, ERIC STEPHAN
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:STEPHAN
Last Name:OSBORN
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 1:11910 PROMONTORY CT
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46236-8985
Mailing Address - Country:US
Mailing Address - Phone:317-709-5031
Mailing Address - Fax:
Practice Address - Street 1:11910 PROMONTORY CT
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46236-8985
Practice Address - Country:US
Practice Address - Phone:317-709-5031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program