Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | E7380 | AR |
Y | 207ND0101X | MOHS-Micrographic Surgeon | E7380 | AR |
NPI | 1003013384 |
---|---|
Provider Name | Dr. Michael Frederick Osleber |
First Address | North Little Rock, AR 72117 |
Second Address | Little Rock, AR 72205-6375 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2007 |
Last Update Date | 29/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
191894001 | (05) | AR |
5AP05F186 | MEDICARE PTAN (01) | AR |