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NPI Code Detail

MEDICARE: DR. ANDREW WADE OSBURN M.D.

MEDICARE: DR. ANDREW WADE OSBURN 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
12085R0202XDiagnostic Radiology Physician16434ND
22085R0202XDiagnostic Radiology PhysicianG75889CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P0030291OTHERCARR MC
200G758890OTHERCABS
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1942206990
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ANDREW WADE OSBURN M.D.
Provider Business Mailing Address
First Line : PO BOX 5074
Second Line :
City : SIOUX FALLS
State : SD
Zip : 57117-5074
Country : US
Telephone Number :
Fax Number : 805-569-2964
Provider Business Practice Location Address
First Line : 801 BROADWAY N
Second Line :
City : FARGO
State : ND
Zip : 58102-3641
Country : US
Telephone Number : 701-234-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/23/2005
Last Update Date : 10/31/2024

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