Provider Demographics
NPI:1396402533
Name:OWENS, DHAHABU MFALME HATARI
Entity Type:Individual
Prefix:MR
First Name:DHAHABU
Middle Name:MFALME HATARI
Last Name:OWENS
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 1:58 CAROLYN CT
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62702-1563
Mailing Address - Country:US
Mailing Address - Phone:217-416-5214
Mailing Address - Fax:
Practice Address - Street 1:58 CAROLYN CT
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-1563
Practice Address - Country:US
Practice Address - Phone:217-416-5214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-23
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILO52017376137347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle