Provider Demographics
NPI:1639584279
Name:OSAWE, FAITHFUL OSAREKPAMA (MD)
Entity type:Individual
Prefix:
First Name:FAITHFUL
Middle Name:OSAREKPAMA
Last Name:OSAWE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:FAITHFUL
Other - Middle Name:OSAREKPAMA
Other - Last Name:IGHALO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:770 W GRANADA BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-5179
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1879 NIGHTINGALE LN STE C1
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-4363
Practice Address - Country:US
Practice Address - Phone:352-742-1171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-23
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036142779207R00000X, 208M00000X
FLME157565207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist