Provider Demographics
NPI:1710478847
Name:OSMAN, OSAMA (MD)
Entity Type:Individual
Prefix:
First Name:OSAMA
Middle Name:
Last Name:OSMAN
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 1:15700 NW 2ND AVE APT 109
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33169-6747
Mailing Address - Country:US
Mailing Address - Phone:305-813-4473
Mailing Address - Fax:
Practice Address - Street 1:1475 W 49 PLACE
Practice Address - Street 2:LARKIN PALM SPRINGS
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012
Practice Address - Country:US
Practice Address - Phone:305-558-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-24
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT215309207RN0300X
FL32035207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL32035OtherGERIATRIC MEDICINE
FL119177400Medicaid