Healthcare Provider Details

I. General information

NPI: 1629483391
Provider Name (Legal Business Name): OSAMA ELATTAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2014
Last Update Date: 06/15/2022
Certification Date: 06/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 HOSPITAL DR
TOLEDO OH
43614-8001
US

IV. Provider business mailing address

3355 GLENDALE AVE FL 3
TOLEDO OH
43614-2426
US

V. Phone/Fax

Practice location:
  • Phone: 419-383-3761
  • Fax: 419-383-6255
Mailing address:
  • Phone: 419-383-3761
  • Fax: 419-383-6255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number264467
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number35.133537
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: