Basic Information
| Provider Information | |||||||||
| NPI: | 1609283936 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OSETINSKY | ||||||||
| FirstName: | LARA | ||||||||
| MiddleName: | MARIEL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | OSETINSKY | ||||||||
| OtherFirstName: | L. MARIEL | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1720 NICHOLASVILLE RD STE 500 | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405031487 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592781114 | ||||||||
| FaxNumber: | 8592770541 | ||||||||
| Practice Location | |||||||||
| Address1: | 1720 NICHOLASVILLE RD STE 500 | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 40503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592781114 | ||||||||
| FaxNumber: | 8592770541 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2014 | ||||||||
| LastUpdateDate: | 09/17/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
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| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | 1609283936 | MN | N | Allopathic & Osteopathic Physicians | Otolaryngology | 207Y00000X | 59516 | MN | N | Allopathic & Osteopathic Physicians | Otolaryngology | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Y00000X | 52806 | KY | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
No ID Information.