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NPI Code Detail

MEDICARE: STEPHEN OSTERBERG

MEDICARE: STEPHEN OSTERBERG
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
1208600000XSurgery PhysicianA195723CA

General Provider Information

NPI Number : 1457814071
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHEN OSTERBERG
Provider Business Mailing Address
First Line : 303 PARKWAY DR NE
Second Line :
City : ATLANTA
State : GA
Zip : 30312-1212
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2175 SOUTH AVE
Second Line :
City : SOUTH LAKE TAHOE
State : CA
Zip : 96150-7024
Country : US
Telephone Number : 530-543-5691
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/10/2019
Last Update Date : 12/05/2024

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Directions to “ STEPHEN OSTERBERG ” Practice Location

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