Provider Demographics
NPI:1861027229
Name:ODAMAH, JOHN KARIM
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:KARIM
Last Name:ODAMAH
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 1:15003 TURPHIN WAY
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77498-7401
Mailing Address - Country:US
Mailing Address - Phone:713-553-1415
Mailing Address - Fax:
Practice Address - Street 1:15003 TURPHIN WAY
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77498-7401
Practice Address - Country:US
Practice Address - Phone:713-553-1415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-05
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX311125164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse