Provider Demographics
NPI:1629101019
Name:ATALLAH, OSAMA BISHER (MD)
Entity Type:Individual
Prefix:
First Name:OSAMA
Middle Name:BISHER
Last Name:ATALLAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SAM
Other - Middle Name:B
Other - Last Name:ATALLAH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:242 LOCH LOMOND DR
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-3316
Mailing Address - Country:US
Mailing Address - Phone:407-599-9705
Mailing Address - Fax:
Practice Address - Street 1:242 LOCH LOMOND DR
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-3316
Practice Address - Country:US
Practice Address - Phone:407-303-5191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5663208C00000X
FLME99433208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery