Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | JO013255 | MI |
NPI | 1003892944 |
---|---|
Provider Name | Dr. James J Osetek |
First Address | Petoskey, MI 49770-2489 |
Second Address | Petoskey, MI 49770-2489 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2005 |
Last Update Date | 27/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0B46032 | BCBSM PROVIDER ID (01) | MI |
1154483014 | NPI ORGANIZATION (01) | |
2773425 | (05) | MI |
2773434 | (05) | MI |
3020517 | (05) | MI |
3020526 | (05) | MI |
BO0128430 | DEA NUMBER (01) | MI |
JO013255 | DENTAL LICENSE (01) | MI |
U23066 | (02) | MI |