Healthcare Provider Details

I. General information

NPI: 1902165046
Provider Name (Legal Business Name): OMAR SYED M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2012
Last Update Date: 07/12/2021
Certification Date: 07/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6320A W UNION HILLS DR STE 270
GLENDALE AZ
85308-2151
US

IV. Provider business mailing address

6320A W UNION HILLS DR STE 270
GLENDALE AZ
85308-2151
US

V. Phone/Fax

Practice location:
  • Phone: 480-561-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number54263
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number54263
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number54263
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: