Healthcare Provider Details

I. General information

NPI: 1912252321
Provider Name (Legal Business Name): OMAR MARAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2012
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6036 N 19TH AVE STE 208
PHOENIX AZ
85015-2104
US

IV. Provider business mailing address

4022 E GREENWAY RD STE 11-195
PHOENIX AZ
85032-4797
US

V. Phone/Fax

Practice location:
  • Phone: 480-896-9888
  • Fax: 602-953-5466
Mailing address:
  • Phone: 480-896-9888
  • Fax: 602-953-5466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMT202922
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4301113819
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number4301113819
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: