Healthcare Provider Details

I. General information

NPI: 1952460669
Provider Name (Legal Business Name): KHADRA M OSMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 09/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 SOUTH EAST THIRD AVENUE 400
FORT LAUDERDALE FL
33316-2521
US

IV. Provider business mailing address

1625 SOUTH EAST THIRD AVENUE 400
FORT LAUDERDALE FL
33316-2521
US

V. Phone/Fax

Practice location:
  • Phone: 954-832-0055
  • Fax: 954-832-0063
Mailing address:
  • Phone: 954-832-0055
  • Fax: 954-832-0063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberME0060084
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: