Provider Demographics
NPI:1215433461
Name:OSUMAH, TIJANI SHEU AMADU (MD)
Entity type:Individual
Prefix:DR
First Name:TIJANI
Middle Name:SHEU AMADU
Last Name:OSUMAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 689022
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37068-9022
Mailing Address - Country:US
Mailing Address - Phone:615-465-7211
Mailing Address - Fax:
Practice Address - Street 1:2755 SILVER CREEK RD STE 111
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-8343
Practice Address - Country:US
Practice Address - Phone:928-704-7163
Practice Address - Fax:928-704-7140
Is Sole Proprietor?:No
Enumeration Date:2018-04-04
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN29187208600000X
MI4351051323208600000X
AZ71976208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery