Healthcare Provider Details

I. General information

NPI: 1144210022
Provider Name (Legal Business Name): OSAMA A HLALAH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-3053
US

IV. Provider business mailing address

500 E CENTRAL AVE
WINTER HAVEN FL
33880-3053
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-7832
  • Fax: 352-273-7849
Mailing address:
  • Phone: 863-293-1191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number39488
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberME101695
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: