Healthcare Provider Details

I. General information

NPI: 1689967705
Provider Name (Legal Business Name): OSAMA ALSARA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2011
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

138 SERVICE RD A225 CLINICAL CENTER
EAST LANSING MI
48824-1376
US

IV. Provider business mailing address

611 W PARK ST
URBANA IL
61801-2501
US

V. Phone/Fax

Practice location:
  • Phone: 517-353-4941
  • Fax: 517-432-3145
Mailing address:
  • Phone: 217-383-3311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301098270
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number036145248
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: