Provider Demographics
NPI:1093030173
Name:ROBERT N. OSDYKE, INC
Entity type:Organization
Organization Name:ROBERT N. OSDYKE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:N
Authorized Official - Last Name:OSDYKE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:636-207-0444
Mailing Address - Street 1:15421 CLAYTON RD
Mailing Address - Street 2:SUITE G1
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-3161
Mailing Address - Country:US
Mailing Address - Phone:636-207-0444
Mailing Address - Fax:636-207-0446
Practice Address - Street 1:15421 CLAYTON RD
Practice Address - Street 2:SUITE G1
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63011-3161
Practice Address - Country:US
Practice Address - Phone:636-207-0444
Practice Address - Fax:636-207-0446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-01
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000427213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOT42874Medicare UPIN