Provider Demographics
NPI:1386742864
Name:OSMAN, KHIDIR A (MD)
Entity type:Individual
Prefix:DR
First Name:KHIDIR
Middle Name:A
Last Name:OSMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:789 W 27TH ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-7207
Mailing Address - Country:US
Mailing Address - Phone:928-344-8400
Mailing Address - Fax:928-344-8412
Practice Address - Street 1:789 W 27TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-7207
Practice Address - Country:US
Practice Address - Phone:928-344-8400
Practice Address - Fax:928-344-8412
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2023-05-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ28831207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ547573Medicaid
AZ76458Medicare PIN
AZ547573Medicaid