Basic Information
| Provider Information | |||||||||
| NPI: | 1588087068 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ELSALLABI | ||||||||
| FirstName: | OSAMA | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 636 DEES STREET | ||||||||
| Address2: | |||||||||
| City: | MISURATA | ||||||||
| State: | MISURATA | ||||||||
| PostalCode: | NA | ||||||||
| CountryCode: | LY | ||||||||
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| Practice Location | |||||||||
| Address1: | 601 N 30TH ST DEPT OF | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681312137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4022804180 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/04/2014 | ||||||||
| LastUpdateDate: | 02/06/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 7041 | NE | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 49192 | KY | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 7100436730 | 05 | KY | MEDICAID |