Provider Demographics
NPI:1003214107
Name:AWASUM, MICHAEL CHIBAKA (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:CHIBAKA
Last Name:AWASUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:234-A PARQUE INDUSTRIAL SABANETA
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716
Mailing Address - Country:US
Mailing Address - Phone:787-841-8645
Mailing Address - Fax:787-848-4043
Practice Address - Street 1:234-A PARQUE INDUSTRIAL SABANETA
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716
Practice Address - Country:US
Practice Address - Phone:787-841-8645
Practice Address - Fax:787-848-4043
Is Sole Proprietor?:No
Enumeration Date:2014-12-05
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18663207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology