Healthcare Provider Details

I. General information

NPI: 1598022725
Provider Name (Legal Business Name): OMAR NADHEM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2012
Last Update Date: 07/29/2021
Certification Date: 07/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 NORTH CENTRAL AVENUE
PHOENIX AZ
85012
US

IV. Provider business mailing address

2901 NORTH CENTRAL AVENUE SUITE 160
PHEONIX AZ
85012
US

V. Phone/Fax

Practice location:
  • Phone: 918-502-1900
  • Fax:
Mailing address:
  • Phone: 804-828-4060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number0116030678
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: