Healthcare Provider Details

I. General information

NPI: 1346407525
Provider Name (Legal Business Name): MOHAMMAD OSMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2008
Last Update Date: 02/08/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 W 13 MILE RD STE 707 BEAUMONT CHILDREN'S HOSPITAL PEDIATRIC GASTROENTEROLOGY
ROYAL OAK MI
48073-6770
US

IV. Provider business mailing address

3535 W 13 MILE RD STE 707 BEAUMONT CHILDREN'S HOSPITAL PEDIATRIC GASTROENTEROLOGY
ROYAL OAK MI
48073-6770
US

V. Phone/Fax

Practice location:
  • Phone: 248-551-0487
  • Fax: 248-551-3696
Mailing address:
  • Phone: 248-551-0487
  • Fax: 248-551-3696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number4301104035
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: