Healthcare Provider Details

I. General information

NPI: 1487727079
Provider Name (Legal Business Name): OMENI N OSIAN M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 06/06/2024
Certification Date: 06/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 SE 16TH AVE STE 303
OCALA FL
34471-4620
US

IV. Provider business mailing address

1500 SE MAGNOLIA EXT SUITE 203
OCALA FL
34471-4463
US

V. Phone/Fax

Practice location:
  • Phone: 352-369-0288
  • Fax: 352-867-1053
Mailing address:
  • Phone: 352-351-1883
  • Fax: 352-351-1643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberME105597
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: