NPI Code Detail JSON Logo

1104095132 NPI number — MAMUDU BALIMA ISSAH MT

NPI Number: 1104095132
Health Care Provider/Practitioner: MAMUDU BALIMA ISSAH MT

Information about “1104095132” NPI (MAMUDU BALIMA ISSAH MT) exists in 1104095132 in HTML format HTML  |  1104095132 in plain Text format TXT  |  1104095132 in PDF (Portable Document Format) PDF  |  1104095132 in an XML format XML  formats.

NPI Number : 1104095132 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1104095132",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "ISSAH",
    "FirstName": "MAMUDU",
    "MiddleName": "BALIMA",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "PO BOX 192",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "EULESS",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "76039-0192",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "682-465-7542",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1307 CEDAR RIDGE TER",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "EULESS",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "76039-2807",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "682-465-7542",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "02/24/2008",
    "LastUpdateDate": "02/24/2008",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "291U00000X",
        "TaxonomyName": "Clinical Medical Laboratory",
        "LicenseNumber": "51513",
        "LicenseNumberStateCode": "IL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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