Provider Demographics
NPI:1730527631
Name:OSBORNE, JEFFREY DONALD (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:DONALD
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:DEPT 771797
Mailing Address - Street 2:P O BOX 77000
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48277-1797
Mailing Address - Country:US
Mailing Address - Phone:989-799-5557
Mailing Address - Fax:
Practice Address - Street 1:5483 GRATIOT RD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48638-6037
Practice Address - Country:US
Practice Address - Phone:989-799-5557
Practice Address - Fax:989-401-8240
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-13
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301103238207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery