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: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8930 W SUNSET RD STE 300
LAS VEGAS NV
89148-5013
US

IV. Provider business mailing address

8930 W SUNSET RD STE 300
LAS VEGAS NV
89148-5013
US

V. Phone/Fax

Practice location:
  • Phone: 702-258-7788
  • Fax:
Mailing address:
  • Phone: 702-258-7788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number71976
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4351051323
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number28449
License Number StateNV
# 4
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number29187
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: