Provider Demographics
NPI:1831292069
Name:OSMANI, BASITH MAHMOOD (MD FRCS)
Entity Type:Individual
Prefix:
First Name:BASITH
Middle Name:MAHMOOD
Last Name:OSMANI
Suffix:
Gender:M
Credentials:MD FRCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10167 E DEER CREEK LN
Mailing Address - Street 2:
Mailing Address - City:ROCHELLE
Mailing Address - State:IL
Mailing Address - Zip Code:61068
Mailing Address - Country:US
Mailing Address - Phone:815-761-7226
Mailing Address - Fax:
Practice Address - Street 1:1219 CURRENCY CT
Practice Address - Street 2:
Practice Address - City:ROCHELLE
Practice Address - State:IL
Practice Address - Zip Code:61068-2321
Practice Address - Country:US
Practice Address - Phone:815-562-4500
Practice Address - Fax:815-562-5151
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036084977207Q00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL07132007OtherBCBS
IL611373400OtherUS DEPT OF LABOR
IL036084977Medicaid
IL036084977Medicaid
F23524Medicare UPIN
IL208332Medicare ID - Type Unspecified