Provider Demographics
NPI:1306548631
Name:WARSAME, MUSTAF OSMAN
Entity type:Individual
Prefix:
First Name:MUSTAF
Middle Name:OSMAN
Last Name:WARSAME
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 1:3969 BLACK PINE DR
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-1194
Mailing Address - Country:US
Mailing Address - Phone:614-594-9572
Mailing Address - Fax:
Practice Address - Street 1:3969 BLACK PINE DR
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-1194
Practice Address - Country:US
Practice Address - Phone:614-594-9572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)