Provider Demographics
NPI:1104300953
Name:MALISAWA, HUSSEIN MUSTAPHA SR (TRANSPORT PROVIDER)
Entity type:Individual
Prefix:
First Name:HUSSEIN
Middle Name:MUSTAPHA
Last Name:MALISAWA
Suffix:SR
Gender:M
Credentials:TRANSPORT PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16730 W 127TH ST
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-1418
Mailing Address - Country:US
Mailing Address - Phone:913-353-2022
Mailing Address - Fax:
Practice Address - Street 1:16730 W 127TH ST
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-1418
Practice Address - Country:US
Practice Address - Phone:913-353-2022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-18
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSK01395704343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)