Healthcare Provider Details

I. General information

NPI: 1467719492
Provider Name (Legal Business Name): OSMAN ZAKI AHMAD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2012
Last Update Date: 12/07/2022
Certification Date: 12/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

517 HEALTH BLVD
DAYTONA BEACH FL
32114-1493
US

IV. Provider business mailing address

608 MAITLAND AVE
ALTAMONTE SPRINGS FL
32701-6834
US

V. Phone/Fax

Practice location:
  • Phone: 386-256-4031
  • Fax: 386-256-7151
Mailing address:
  • Phone: 321-274-7519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number134079
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: