MEDICARE: HUSSEIN OTHMAN M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	5315035401	MI
2	207RC0000X	Cardiovascular Disease Physician	4301091824	MI

General Provider Information

NPI Number	:	1306089040
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HUSSEIN OTHMAN M.D

Provider Business Mailing Address
First Line	:	205 PAGE AVE STE B
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49201-2462
Country	:	US
Telephone Number	:	517-787-3577
Fax Number	:

Provider Business Practice Location Address
First Line	:	205 PAGE AVE STE B
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49201-2462
Country	:	US
Telephone Number	:	517-787-3577
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/10/2009
Last Update Date	:	06/21/2019

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