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General NPI Number Information
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NPI Number | 1700109568
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Entity Type | Organization
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Legal Business Name | STACY C OSBORNE
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Dates
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Enumeration Date | 03/09/2010
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Last Update Date | 03/22/2016
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Provider Practice Location Address
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Address Line | 5521 MONTGOMERY RD
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City | CINCINNATI
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State | OH
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Zip | 45212-1848
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Country | US
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Telephone | 513-351-6300
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Fax | 513-351-9951
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Provider Business Mailing Address
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Address Line | 5521 MONTGOMERY RD
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City | CINCINNATI
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State | OH
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Zip | 45212-1848
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Country | US
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Telephone | 513-351-6300
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Fax | 513-351-9951
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Authorized Official
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Title or Position | DPM/OWNER
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Name | STACY OSBORNE
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Credential |
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Telephone | 513-351-6300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 36002140
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License Number State | OH
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