Provider Demographics
NPI:1740598523
Name:RASLAN, OSAMA ANWAR AHMED (MD, MBBCH)
Entity type:Individual
Prefix:
First Name:OSAMA
Middle Name:ANWAR AHMED
Last Name:RASLAN
Suffix:
Gender:M
Credentials:MD, MBBCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8613 ROCKEFELLER AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60513-1414
Mailing Address - Country:US
Mailing Address - Phone:205-201-8428
Mailing Address - Fax:
Practice Address - Street 1:2160 S 1ST AVE RM 833
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153-3328
Practice Address - Country:US
Practice Address - Phone:708-216-3926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-15
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036140283207U00000X, 2085N0700X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program