MEDICARE: DR. KENNETH DWIGHT OSORIO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	202K00000X	Phlebology Physician	24474	AZ

General Provider Information

NPI Number	:	1245229087
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH DWIGHT OSORIO MD

Provider Business Mailing Address
First Line	:	3514 N POWER RD
Second Line	:	SUITE 118
City	:	MESA
State	:	AZ
Zip	:	85215-2903
Country	:	US
Telephone Number	:	480-844-8346
Fax Number	:	480-889-6997

Provider Business Practice Location Address
First Line	:	3514 N POWER RD
Second Line	:	SUITE 118
City	:	MESA
State	:	AZ
Zip	:	85215-2903
Country	:	US
Telephone Number	:	480-844-8346
Fax Number	:	480-844-3889

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/14/2005
Last Update Date	:	09/29/2025

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