Provider Demographics
NPI:1801617899
Name:NDANUSA, UMAR SADIQ
Entity type:Individual
Prefix:
First Name:UMAR
Middle Name:SADIQ
Last Name:NDANUSA
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 1:112 SWEETGUM DR
Mailing Address - Street 2:
Mailing Address - City:MURPHY
Mailing Address - State:TX
Mailing Address - Zip Code:75094-3441
Mailing Address - Country:US
Mailing Address - Phone:310-968-9940
Mailing Address - Fax:
Practice Address - Street 1:112 SWEETGUM DR
Practice Address - Street 2:
Practice Address - City:MURPHY
Practice Address - State:TX
Practice Address - Zip Code:75094-3441
Practice Address - Country:US
Practice Address - Phone:310-968-9940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-22
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver