Provider Demographics
NPI:1275677601
Name:OSUAMADI, AHINZE CAJETAN (RPT)
Entity Type:Individual
Prefix:
First Name:AHINZE
Middle Name:CAJETAN
Last Name:OSUAMADI
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5747 N BERRY ST
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-8101
Mailing Address - Country:US
Mailing Address - Phone:734-674-1168
Mailing Address - Fax:
Practice Address - Street 1:5747 N BERRY ST
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-8101
Practice Address - Country:US
Practice Address - Phone:734-674-1168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-18
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501005748225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4370968Medicaid
MIMI1524Medicare PIN