Provider Demographics
NPI:1407825243
Name:OSMAN, FARHAT (MD)
Entity Type:Individual
Prefix:DR
First Name:FARHAT
Middle Name:
Last Name:OSMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2840 CROOKS RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-3676
Mailing Address - Country:US
Mailing Address - Phone:248-844-8890
Mailing Address - Fax:248-844-8891
Practice Address - Street 1:2840 CROOKS RD
Practice Address - Street 2:SUITE 100
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309-3676
Practice Address - Country:US
Practice Address - Phone:248-844-8890
Practice Address - Fax:248-844-8891
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-15
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301057017208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4439210Medicaid
MI4439210Medicaid
OF36132Medicare ID - Type Unspecified