Provider Demographics
NPI:1912408121
Name:SAWAGED, OSAMA WADIE
Entity Type:Individual
Prefix:
First Name:OSAMA
Middle Name:WADIE
Last Name:SAWAGED
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 1:17641 W 83RD PL
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80007-6878
Mailing Address - Country:US
Mailing Address - Phone:720-400-5449
Mailing Address - Fax:
Practice Address - Street 1:17641 W 83RD PL
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80007-6878
Practice Address - Country:US
Practice Address - Phone:720-400-5449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-22
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO$$$$$$$$$Medicaid