Healthcare Provider Details

I. General information

NPI: 1588639777
Provider Name (Legal Business Name): NIAZ USMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 02/28/2025
Certification Date: 02/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 SYLVANIA DR
BEAVERCREEK OH
45440-3237
US

IV. Provider business mailing address

ONE GI CREDENTIALING DEPARTMENT PO BOX 381468
GERMANTOWN TN
38183-3237
US

V. Phone/Fax

Practice location:
  • Phone: 937-320-5050
  • Fax: 937-320-5060
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number35066544
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: