Provider Demographics
NPI:1881762334
Name:OSMAN-MALIK, YAHYA M (MD)
Entity type:Individual
Prefix:
First Name:YAHYA
Middle Name:M
Last Name:OSMAN-MALIK
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 1:400 MACK AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2136
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4160 JOHN R
Practice Address - Street 2:SUITE 917
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2020
Practice Address - Country:US
Practice Address - Phone:313-745-4525
Practice Address - Fax:313-745-0011
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301065429207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
YO065429OtherCHAMPUS-CHAMPUS
MI413396310Medicaid
700H262220OtherBLUE CROSS-BLUE CROSS
YO065429OtherCOMMERCIAL-COMMERCIAL NUMBER
MI413396310Medicaid
YO065429OtherCHAMPUS-CHAMPUS
MI0P30630768Medicare PIN