Provider Demographics
NPI:1225454671
Name:INTERNAL MEDICINE CLINIC
Entity Type:Organization
Organization Name:INTERNAL MEDICINE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AYMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:OSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-684-2929
Mailing Address - Street 1:2210 E HILLSBOROUGH AVE
Mailing Address - Street 2:UNIT#6
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33610-4450
Mailing Address - Country:US
Mailing Address - Phone:813-237-2090
Mailing Address - Fax:352-684-2646
Practice Address - Street 1:2210 E HILLSBOROUGH AVE
Practice Address - Street 2:UNIT#6
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33610-4450
Practice Address - Country:US
Practice Address - Phone:813-237-2090
Practice Address - Fax:352-684-2646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-10
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0069703183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF97852Medicare UPIN