Provider Demographics
NPI:1518640788
Name:AWOSIKA, BERNADETTE B (PA)
Entity type:Individual
Prefix:MRS
First Name:BERNADETTE
Middle Name:B
Last Name:AWOSIKA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:BERNADETTE
Other - Middle Name:B
Other - Last Name:OSBORNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:348 E 9 MILE RD
Mailing Address - Street 2:
Mailing Address - City:HAZEL PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48030-1854
Mailing Address - Country:US
Mailing Address - Phone:248-268-2566
Mailing Address - Fax:
Practice Address - Street 1:348 E 9 MILE RD
Practice Address - Street 2:
Practice Address - City:HAZEL PARK
Practice Address - State:MI
Practice Address - Zip Code:48030-1854
Practice Address - Country:US
Practice Address - Phone:248-268-2566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-14
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601012620207Q00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine