Provider Demographics
NPI:1952460669
Name:OSMAN, KHADRA M (MD)
Entity Type:Individual
Prefix:
First Name:KHADRA
Middle Name:M
Last Name:OSMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 SOUTH EAST THIRD AVENUE
Mailing Address - Street 2:400
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-2521
Mailing Address - Country:US
Mailing Address - Phone:954-832-0055
Mailing Address - Fax:954-832-0063
Practice Address - Street 1:1625 SOUTH EAST THIRD AVENUE
Practice Address - Street 2:400
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-2521
Practice Address - Country:US
Practice Address - Phone:954-832-0055
Practice Address - Fax:954-832-0063
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0060084207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL370049600Medicaid
FLK1971Medicare ID - Type Unspecified
FL370049600Medicaid
FLE41461Medicare UPIN