Healthcare Provider Details

I. General information

NPI: 1508432436
Provider Name (Legal Business Name): AMIRA MOHAMED AHMED OTHMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2021
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 E MICHIGAN AVE STE 145
LANSING MI
48912-1897
US

IV. Provider business mailing address

804 SERVICE RD STE A202
EAST LANSING MI
48824-7015
US

V. Phone/Fax

Practice location:
  • Phone: 517-364-5440
  • Fax: 517-364-5409
Mailing address:
  • Phone: 517-364-5440
  • Fax: 517-364-5409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301510926
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: