Provider Demographics
NPI:1144233875
Name:KADRY, OTHMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:OTHMAN
Middle Name:
Last Name:KADRY
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 1:44038 WOODWARD AVENUE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-5037
Mailing Address - Country:US
Mailing Address - Phone:248-338-6611
Mailing Address - Fax:248-338-4742
Practice Address - Street 1:44038 WOODWARD AVENUE
Practice Address - Street 2:SUITE 201
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-5037
Practice Address - Country:US
Practice Address - Phone:248-338-6611
Practice Address - Fax:248-338-4742
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIOK034855207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3112637Medicaid
MI3112637Medicaid
0826159Medicare ID - Type Unspecified