Healthcare Provider Details

I. General information

NPI: 1518495225
Provider Name (Legal Business Name): KAZEM MAHMOUD OSMAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2017
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 N EAST AVE
JACKSON MI
49201-1753
US

IV. Provider business mailing address

33333 W 12 MILE RD STE A
FARMINGTON HILLS MI
48334-3312
US

V. Phone/Fax

Practice location:
  • Phone: 517-205-3998
  • Fax: 517-205-7050
Mailing address:
  • Phone: 248-536-2127
  • Fax: 248-893-6952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number5101025424
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101025424
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: