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General NPI Number Information
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NPI Number | 1255101879
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Entity Type | Individual
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Provider Name | MR. OSAMWONYI MICHAEL OSAGIEDE
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Gender | Male
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Dates
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Enumeration Date | 01/04/2024
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Last Update Date | 01/04/2024
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Provider Practice Location Address
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Address Line | 401 GARLAND DR APT 260
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City | LAKE JACKSON
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State | TX
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Zip | 77566-6248
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Country | US
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Telephone | 832-709-9852
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Fax |
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Provider Business Mailing Address
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Address Line | 415 GARLAND DR APT 260
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City | LAKE JACKSON
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State | TX
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Zip | 77566-6293
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Country | US
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Telephone | 832-709-9852
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number |
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License Number State | TX
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