Provider Demographics
NPI:1013399583
Name:IDOWU, HAFEEZ
Entity Type:Individual
Prefix:
First Name:HAFEEZ
Middle Name:
Last Name:IDOWU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9435 MUIRKIRK RD
Mailing Address - Street 2:APT 202
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-2756
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9435 MUIRKIRK RD
Practice Address - Street 2:APT 202
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-2756
Practice Address - Country:US
Practice Address - Phone:301-379-1805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-22
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide