Provider Demographics
NPI:1467719492
Name:AHMAD, OSMAN ZAKI (MD)
Entity Type:Individual
Prefix:
First Name:OSMAN
Middle Name:ZAKI
Last Name:AHMAD
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 1:608 MAITLAND AVE
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-6834
Mailing Address - Country:US
Mailing Address - Phone:321-274-7519
Mailing Address - Fax:
Practice Address - Street 1:517 HEALTH BLVD
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-1493
Practice Address - Country:US
Practice Address - Phone:386-256-4031
Practice Address - Fax:386-256-7151
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-16
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1340792080P0206X
AL343722080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric GastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL024786900Medicaid
AL175294Medicaid