Healthcare Provider Details

I. General information

NPI: 1477816890
Provider Name (Legal Business Name): OMAR A ZWAIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2012
Last Update Date: 12/22/2022
Certification Date: 12/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N EDINBURGH DR STE 102
WINTER PARK FL
32792-4125
US

IV. Provider business mailing address

22255 GREENFIELD RD STE 352
SOUTHFIELD MI
48075-3712
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-4190
  • Fax: 407-303-4192
Mailing address:
  • Phone: 248-849-3401
  • Fax: 248-849-4106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number4301101301
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number4301101301
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME159490
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: