MEDICARE: MARIAM AWO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	208D00000X	AZ

General Provider Information

NPI Number	:	1366387540
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIAM AWO

Provider Business Mailing Address
First Line	:	8637 W LOCKLAND CT
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85382
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8637 W LOCKLAND CT
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85382-4725
Country	:	US
Telephone Number	:	586-556-2284
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/22/2026
Last Update Date	:	04/22/2026

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