Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 517 | MN |
NPI | 1053477406 |
---|---|
Provider Name | Dr. Michael Dean O'borsky |
First Address | Buffalo, MN 55313-1930 |
Second Address | Buffalo, MN 55313-1930 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2006 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1053477406 | (05) | MN |
U32428 | (02) | MN |