Healthcare Provider Details

I. General information

NPI: 1588046346
Provider Name (Legal Business Name): SADIYA USMAN M.B.B.S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2015
Last Update Date: 09/03/2020
Certification Date: 09/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1631 11TH ST UNIT B
WICHITA FALLS TX
76301-4332
US

IV. Provider business mailing address

10502 BERMUDA ISLE DR
TAMPA FL
33647-2720
US

V. Phone/Fax

Practice location:
  • Phone: 940-263-3000
  • Fax: 940-263-3018
Mailing address:
  • Phone: 815-517-5376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberR6927
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: