Healthcare Provider Details

I. General information

NPI: 1366784670
Provider Name (Legal Business Name): MOHAMED A OMER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2013
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 MEDICAL PLAZA DR STE 101
LEESBURG FL
34748-7328
US

IV. Provider business mailing address

511 MEDICAL PLAZA DR STE 101
LEESBURG FL
34748-7328
US

V. Phone/Fax

Practice location:
  • Phone: 352-728-6808
  • Fax: 352-728-1743
Mailing address:
  • Phone: 352-728-6808
  • Fax: 352-728-1743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number73295
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number66394
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberME158589
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number73295
License Number StateWI
# 5
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME158589
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: