Healthcare Provider Details

I. General information

NPI: 1073728002
Provider Name (Legal Business Name): OSAMA FAROUQ ALMADHOUN M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2007
Last Update Date: 12/31/2020
Certification Date: 12/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 MAIN ST FL 4
BUFFALO NY
14203-1009
US

IV. Provider business mailing address

1001 MAIN ST FL 5
BUFFALO NY
14203-1009
US

V. Phone/Fax

Practice location:
  • Phone: 716-323-0080
  • Fax: 716-323-0295
Mailing address:
  • Phone: 716-323-0080
  • Fax: 716-323-0295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number298737
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number04-34794
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: