Provider Demographics
NPI:1720172687
Name:OSBORNE, MICHAEL FREDERICK (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:FREDERICK
Last Name:OSBORNE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 MORRIS HILL RD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-2818
Mailing Address - Country:US
Mailing Address - Phone:423-499-1204
Mailing Address - Fax:423-499-2320
Practice Address - Street 1:2200 MORRIS HILL RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-2818
Practice Address - Country:US
Practice Address - Phone:423-499-1204
Practice Address - Fax:423-499-2320
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000461302084P0800X
TNMD00000419132084P0800X
GA0546432084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7128648Medicaid
WA7128648Medicaid
WA8854969Medicare ID - Type UnspecifiedMEDICARE GROUP