Healthcare Provider Details

I. General information

NPI: 1801414206
Provider Name (Legal Business Name): ABDUL-FATAWU OSMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2020
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 WILLOW CREEK RD STE 2200
PRESCOTT AZ
86301-1614
US

IV. Provider business mailing address

2529 W CACTUS RD APT 2054
PHOENIX AZ
85029-2521
US

V. Phone/Fax

Practice location:
  • Phone: 928-445-6025
  • Fax: 928-778-3026
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number70289
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number70289
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: