Provider Demographics
NPI:1376634741
Name:ABOUL-FETTOUH, OSAMA (MD)
Entity Type:Individual
Prefix:
First Name:OSAMA
Middle Name:
Last Name:ABOUL-FETTOUH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:OSAMA
Other - Middle Name:A
Other - Last Name:FETTOUH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1935 MEDICAL DISTRICT DR
Mailing Address - Street 2:DEPARTMENT OF ANESTHESIOLOGY
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-7701
Mailing Address - Country:US
Mailing Address - Phone:214-456-6393
Mailing Address - Fax:214-456-7232
Practice Address - Street 1:1935 MEDICAL DISTRICT DR
Practice Address - Street 2:DEPARTMENT OF ANESTHESIOLOGY
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-7701
Practice Address - Country:US
Practice Address - Phone:214-456-6393
Practice Address - Fax:214-456-7232
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM6994207L00000X, 207LP3000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2010977 01Medicaid
MS07935714Medicaid
MS050000807Medicare ID - Type Unspecified
TX2010977 01Medicaid