Basic Information
| Provider Information | |||||||||
| NPI: | 1881244614 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OSBORNE | ||||||||
| FirstName: | MEREDITH | ||||||||
| MiddleName: | ELISE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3631 N MAGNOLIA AVE APT 3 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606130256 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6786028195 | ||||||||
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| Practice Location | |||||||||
| Address1: | JOINT RELIEF INSTITUTE | ||||||||
| Address2: | 600 22ND STREET | ||||||||
| City: | OAK BROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60523 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7089145145 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2019 | ||||||||
| LastUpdateDate: | 09/13/2019 | ||||||||
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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 | 208VP0000X | 085.007237 | IL | Y | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 085.007237 | 01 | IL | ILLINOIS STATE PHYSICIAN ASSISTANT LICENSE | OTHER |