Provider Demographics
NPI:1073696167
Name:OSMAN, MITCHEL (MD)
Entity Type:Individual
Prefix:MR
First Name:MITCHEL
Middle Name:
Last Name:OSMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 E BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858
Mailing Address - Country:US
Mailing Address - Phone:989-773-6300
Mailing Address - Fax:989-772-9001
Practice Address - Street 1:617 E BROADWAY
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858
Practice Address - Country:US
Practice Address - Phone:989-773-6300
Practice Address - Fax:989-772-9001
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0565742084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
2603700772OtherBCBSM
MI2659805Medicaid
P65230Medicare UPIN
MI2659805Medicaid