Provider Demographics
NPI:1063164598
Name:AL HALAWAT, OSAMA
Entity type:Individual
Prefix:
First Name:OSAMA
Middle Name:
Last Name:AL HALAWAT
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 1:3416 ELMENDORF PL
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40517-2765
Mailing Address - Country:US
Mailing Address - Phone:859-333-7897
Mailing Address - Fax:
Practice Address - Street 1:3416 ELMENDORF PL
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40517-2765
Practice Address - Country:US
Practice Address - Phone:859-333-7897
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-26
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver