MEDICARE: ABE GOLDSWORTHY OSBOURNE D.P.M.

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	213E00000X	Podiatrist	36002695	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CH5179	OTHER	OH	RR MEDICARE GROUP
3	P00435156	OTHER	OH	RR MEDICARE #

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407941743
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABE GOLDSWORTHY OSBOURNE D.P.M.

Provider Business Mailing Address
First Line	:	23780 HALBURTON RD
Second Line	:
City	:	BEACHWOOD
State	:	OH
Zip	:	44122-7603
Country	:	US
Telephone Number	:	216-765-1559
Fax Number	:	216-765-1559

Provider Business Practice Location Address
First Line	:	4415 EUCLID AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44103-3759
Country	:	US
Telephone Number	:	216-231-5612
Fax Number	:	216-721-5534

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

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	02/22/2008

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