MEDICARE: DR. OMID M SEYLABI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	ME98075	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619097169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OMID M SEYLABI MD

Provider Business Mailing Address
First Line	:	241 LAFAYETTE RD
Second Line	:	APT 341
City	:	SYRACUSE
State	:	NY
Zip	:	13205-2931
Country	:	US
Telephone Number	:	315-416-3753
Fax Number	:

Provider Business Practice Location Address
First Line	:	2100 NE 36TH ST
Second Line	:	SUITE 201
City	:	LIGHTHOUSE POINT
State	:	FL
Zip	:	33064-7574
Country	:	US
Telephone Number	:	954-781-0180
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	06/17/2021

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