Provider Demographics
NPI:1891735148
Name:GALAL, OSAMA (MD)
Entity Type:Individual
Prefix:DR
First Name:OSAMA
Middle Name:
Last Name:GALAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:OSAMA
Other - Middle Name:G M
Other - Last Name:AHMED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:8382 HOLLY RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-1971
Mailing Address - Country:US
Mailing Address - Phone:810-771-0010
Mailing Address - Fax:810-771-0011
Practice Address - Street 1:8382 HOLLY RD
Practice Address - Street 2:SUITE 2
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-1971
Practice Address - Country:US
Practice Address - Phone:810-771-0010
Practice Address - Fax:810-771-0011
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301076360207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4938391Medicaid
MI3502512792OtherBCBS
MI3502512792OtherBCBS