MEDICARE: OSAMA ANSARI LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679056311
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OSAMA ANSARI LLC

Provider Business Mailing Address
First Line	:	1551 BOREN DR STE B
Second Line	:
City	:	OCOEE
State	:	FL
Zip	:	34761-2966
Country	:	US
Telephone Number	:	407-284-7420
Fax Number	:

Provider Business Practice Location Address
First Line	:	1551 BOREN DR STE B
Second Line	:
City	:	OCOEE
State	:	FL
Zip	:	34761-2966
Country	:	US
Telephone Number	:	407-284-7420
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	RAMEEZ AHMED
Credential	:
Telephone Number	:	407-284-7420

Provider Enumeration Date	:	09/10/2018
Last Update Date	:	09/10/2018

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Directions to “OSAMA ANSARI LLC ” Practice Location

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