MEDICARE: DR. OSAMA M ISMAEL M.D.

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	15-31528	KS
2	207P00000X	Emergency Medicine Physician	04-31528	KS
3	207P00000X	Emergency Medicine Physician	04315280431528	KS

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00706695	OTHER	KS	RAILROAD MEDICARE

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841241551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OSAMA M ISMAEL M.D.

Provider Business Mailing Address
First Line	:	311 E SPRUCE ST
Second Line	:
City	:	GARDEN CITY
State	:	KS
Zip	:	67846-5614
Country	:	US
Telephone Number	:	620-275-3700
Fax Number	:	620-275-3717

Provider Business Practice Location Address
First Line	:	311 E SPRUCE ST
Second Line	:
City	:	GARDEN CITY
State	:	KS
Zip	:	67846-5614
Country	:	US
Telephone Number	:	620-275-3700
Fax Number	:	620-275-3717

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	12/01/2023

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Directions to “ DR. OSAMA M ISMAEL M.D.” Practice Location

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