Basic Information
| Provider Information | |||||||||
| NPI: | 1538370705 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OSORIO | ||||||||
| FirstName: | MILLICENT | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10701 EAST BLVD | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441061702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4193348943 | ||||||||
| FaxNumber: | 4193348619 | ||||||||
| Practice Location | |||||||||
| Address1: | 10701 EAST BLVD | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441061702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4193348943 | ||||||||
| FaxNumber: | 4193348619 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2007 | ||||||||
| LastUpdateDate: | 11/14/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 4301083392 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 35.089410 | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2771782 | 05 | OH | MEDICAID |