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NPI Code Detail

MEDICARE: DR. KYLE THOMAS OSBORN M.D.

MEDICARE: DR. KYLE THOMAS OSBORN 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
1207Q00000XFamily Medicine Physician224542NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1417942582
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KYLE THOMAS OSBORN M.D.
Provider Business Mailing Address
First Line : 510 GEYSER RD
Second Line :
City : BALLSTON SPA
State : NY
Zip : 12020-3007
Country : US
Telephone Number : 518-289-2720
Fax Number : 518-886-5880
Provider Business Practice Location Address
First Line : 701 SENECA ST STE 646C
Second Line :
City : BUFFALO
State : NY
Zip : 14210-1351
Country : US
Telephone Number : 716-995-4450
Fax Number : 844-206-7424
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/15/2005
Last Update Date : 09/10/2021

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