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NPI Code Detail

MEDICARE: OMAR AL TAMIMI

MEDICARE: OMAR AL TAMIMI
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
1207R00000XInternal Medicine Physician125082047IL

General Provider Information

NPI Number : 1952083974
Entity Type Code : Individual
Provider Name (Legal Business Name) : OMAR AL TAMIMI
Provider Business Mailing Address
First Line : 801 N RUTLEDGE ST
Second Line :
City : SPRINGFIELD
State : IL
Zip : 62702-4933
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 801 N RUTLEDGE ST
Second Line :
City : SPRINGFIELD
State : IL
Zip : 62702-4933
Country : US
Telephone Number : 217-545-8000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/01/2023
Last Update Date : 08/07/2023

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Directions to “ OMAR AL TAMIMI ” Practice Location

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