MEDICARE: DR. KENNETH OSGOOD M.D.

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	208000000X	Pediatrics Physician	7336	NV
2	208000000X	Pediatrics Physician	C31623	CA
3	208000000X	Pediatrics Physician	73-177	NM

General Provider Information

NPI Number	:	1235137647
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH OSGOOD M.D.

Provider Business Mailing Address
First Line	:	8213 POINT VIEW CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-7443
Country	:	US
Telephone Number	:	702-228-2569
Fax Number	:

Provider Business Practice Location Address
First Line	:	8213 POINT VIEW CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-7443
Country	:	US
Telephone Number	:	702-228-2569
Fax Number	:

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

Provider Enumeration Date	:	07/09/2005
Last Update Date	:	07/08/2007

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Directions to “ DR. KENNETH OSGOOD M.D.” Practice Location

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