Healthcare Provider Details

I. General information

NPI: 1215433461
Provider Name (Legal Business Name): TIJANI SHEU AMADU OSUMAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2018
Last Update Date: 06/27/2024
Certification Date: 06/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2755 SILVER CREEK RD STE 111
BULLHEAD CITY AZ
86442-8343
US

IV. Provider business mailing address

PO BOX 689022
FRANKLIN TN
37068-9022
US

V. Phone/Fax

Practice location:
  • Phone: 928-704-7163
  • Fax: 928-704-7140
Mailing address:
  • Phone: 615-465-7211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number29187
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4351051323
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number71976
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: