Healthcare Provider Details

I. General information

NPI: 1245236587
Provider Name (Legal Business Name): MAJDI A OMAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 02/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5510 UTICA RIDGE RD STE 100
DAVENPORT IA
52807-2935
US

IV. Provider business mailing address

5510 UTICA RIDGE RD STE 100
DAVENPORT IA
52807-2935
US

V. Phone/Fax

Practice location:
  • Phone: 563-424-2025
  • Fax: 563-424-2042
Mailing address:
  • Phone: 563-424-2025
  • Fax: 563-424-2042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number32037
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier4225250
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: