Provider Demographics
NPI:1225374853
Name:JUMA, MICHAEL OMONDI
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:OMONDI
Last Name:JUMA
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 1:110 18TH ST NW
Mailing Address - Street 2:107
Mailing Address - City:SAUK RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:56379-8501
Mailing Address - Country:US
Mailing Address - Phone:320-828-4806
Mailing Address - Fax:
Practice Address - Street 1:110 18TH ST NW
Practice Address - Street 2:107
Practice Address - City:SAUK RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56379-8501
Practice Address - Country:US
Practice Address - Phone:320-828-4806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-31
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program