Basic Information
| Provider Information | |||||||||
| NPI: | 1871678151 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OSETINSKY | ||||||||
| FirstName: | GREGORY | ||||||||
| MiddleName: | V | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1720 NICHOLASVILLE RD | ||||||||
| Address2: | STE 500 | ||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405031404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592781114 | ||||||||
| FaxNumber: | 8592770541 | ||||||||
| Practice Location | |||||||||
| Address1: | 1720 NICHOLASVILLE ROAD | ||||||||
| Address2: | SUITE 500 | ||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 40503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592781114 | ||||||||
| FaxNumber: | 8592770541 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2006 | ||||||||
| LastUpdateDate: | 03/28/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | KY26518 | KY | Y | Allopathic & Osteopathic Physicians | Otolaryngology | 207Y00000X | 29708 | MN | N | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 64265184 | 05 | KY | MEDICAID |