Healthcare Provider Details

I. General information

NPI: 1972434892
Provider Name (Legal Business Name): SID OSBORN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3875 BAY RD STE 4S
SAGINAW MI
48603-2423
US

IV. Provider business mailing address

1370 SPRINGWOOD LN
ROCHESTER HILLS MI
48309-2607
US

V. Phone/Fax

Practice location:
  • Phone: 989-583-0000
  • Fax:
Mailing address:
  • Phone: 248-761-5034
  • Fax: 248-761-5034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: