Healthcare Provider Details

I. General information

NPI: 1063004448
Provider Name (Legal Business Name): DR. BREMANSU OSA-ANDREWS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2021
Last Update Date: 02/08/2021
Certification Date: 02/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5253 HARRY HINES BLVD
DALLAS TX
75235-7708
US

IV. Provider business mailing address

10324 WHITINGHAM DR
DALLAS TX
75227-7670
US

V. Phone/Fax

Practice location:
  • Phone: 605-651-3989
  • Fax:
Mailing address:
  • Phone: 605-651-3989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: