Individual provider · NPI-1
Dr. Kenneth Dwight Osorio, MD
Phlebology · Mesa, AZ
NPI number1245229087
StatusActive
Last updated in NPPESSep 29, 2025
Details
- NPI
- 1245229087
- Entity type
- Individual (NPI-1)
- Name
- Dr. Kenneth Dwight Osorio
- Credential
- MD
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Oct 14, 2005
- Certification date
- Sep 29, 2025
- Last updated
- Sep 29, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 202K00000X | Phlebology | 24474 | AZ | Yes |
Practice location
3514 N Power RdSuite 118
Mesa, AZ 85215-2903
Phone 480-844-8346 · Fax 480-844-3889
Mailing address
3514 N Power RdSuite 118
Mesa, AZ 85215-2903
Phone 480-844-8346 · Fax 480-889-6997
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