Provider Demographics
NPI:1356521033
Name:AMBAW, SAMSON MULU (MD)
Entity type:Individual
Prefix:DR
First Name:SAMSON
Middle Name:MULU
Last Name:AMBAW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9230 E. RENO AVE SUITE B
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73130
Mailing Address - Country:US
Mailing Address - Phone:405-737-4900
Mailing Address - Fax:405-737-3606
Practice Address - Street 1:9230 E. RENO AVE SUITE B
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73130
Practice Address - Country:US
Practice Address - Phone:405-737-4900
Practice Address - Fax:405-737-3606
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-09
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA62937207R00000X
OK28940207RN0300X
TXN3441208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist