Healthcare Provider Details

I. General information

NPI: 1720432941
Provider Name (Legal Business Name): OSAMA INTIKHAB M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2016
Last Update Date: 08/15/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9601 BAPTIST HEALTH DR STE 750
LITTLE ROCK AR
72205-6370
US

IV. Provider business mailing address

11001 EXECUTIVE CENTER DR STE 200
LITTLE ROCK AR
72211-4393
US

V. Phone/Fax

Practice location:
  • Phone: 501-224-0200
  • Fax: 501-224-2292
Mailing address:
  • Phone: 501-224-0200
  • Fax: 501-224-2292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberE-18342
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberE-18342
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: