Healthcare Provider Details

I. General information

NPI: 1164687646
Provider Name (Legal Business Name): DAVID CHARLES OSMON PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2008
Last Update Date: 07/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 E NEWPORT AVE SACRED HEART REHABILITATION INSTITUTE
MILWAUKEE WI
53211
US

IV. Provider business mailing address

5723 N CRESTWOOD BLVD
MILWAUKEE WI
53209-4309
US

V. Phone/Fax

Practice location:
  • Phone: 414-298-6700
  • Fax: 414-229-5219
Mailing address:
  • Phone: 414-573-5138
  • Fax: 414-229-5219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number836
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: