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General NPI Number Information
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NPI Number | 1467422097
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Entity Type | Organization
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Legal Business Name | KHADRA M OSMAN M D P A
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Dates
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Enumeration Date | 01/25/2006
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Last Update Date | 08/29/2010
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Provider Practice Location Address
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Address Line | 1625 SE 3RD AVE SUITE 400
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City | FORT LAUDERDALE
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State | FL
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Zip | 33316-2521
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Country | US
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Telephone | 954-832-0055
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Fax | 954-832-0262
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Provider Business Mailing Address
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Address Line | 1625 SE 3RD AVE 400
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City | FORT LAUDERDALE
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State | FL
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Zip | 33316-2521
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Country | US
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Telephone | 954-832-0055
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Fax | 954-832-0262
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KHADRA MOHAMOUD OSMAN
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Credential | M.D.
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Telephone | 954-832-0055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | ME0060084
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License Number State | FL
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