Provider Demographics
NPI:1649540584
Name:OSMAN, ELHADI E
Entity type:Individual
Prefix:
First Name:ELHADI
Middle Name:E
Last Name:OSMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3225 E BASELINE RD
Mailing Address - Street 2:#1090
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-2677
Mailing Address - Country:US
Mailing Address - Phone:480-544-4745
Mailing Address - Fax:
Practice Address - Street 1:3225 E BASELINE RD
Practice Address - Street 2:#1090
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2677
Practice Address - Country:US
Practice Address - Phone:480-544-4745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-10
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)