Provider Demographics
NPI:1841241551
Name:ISMAEL, OSAMA M (MD)
Entity Type:Individual
Prefix:DR
First Name:OSAMA
Middle Name:M
Last Name:ISMAEL
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 1:311 E SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67846-5614
Mailing Address - Country:US
Mailing Address - Phone:620-275-3700
Mailing Address - Fax:620-275-3717
Practice Address - Street 1:311 E SPRUCE ST
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:KS
Practice Address - Zip Code:67846-5614
Practice Address - Country:US
Practice Address - Phone:620-275-3700
Practice Address - Fax:620-275-3717
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-31528207R00000X
KS04-31528207P00000X
KS04315280431528207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200369740EMedicaid
KS200369740FMedicaid
KSP00706695OtherRAILROAD MEDICARE
KS200369740AMedicaid
KSP00706695OtherRAILROAD MEDICARE
KS200369740AMedicaid
KSI050609Medicare UPIN
KSKA1209005Medicare PIN