Provider Demographics
NPI:1588087068
Name:ELSALLABI, OSAMA (MD)
Entity type:Individual
Prefix:
First Name:OSAMA
Middle Name:
Last Name:ELSALLABI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:636 DEES STREET
Mailing Address - Street 2:
Mailing Address - City:MISURATA
Mailing Address - State:MISURATA
Mailing Address - Zip Code:NA
Mailing Address - Country:LY
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:601 N 30TH ST DEPT OF
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131-2137
Practice Address - Country:US
Practice Address - Phone:402-280-4180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-04
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7041207R00000X
KY49192207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100436730Medicaid
KY7100436730Medicaid