Healthcare Provider Details

I. General information

NPI: 1063862712
Provider Name (Legal Business Name): CHRISTOPHER OMERZA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2016
Last Update Date: 07/07/2021
Certification Date: 07/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 LANGWORTHY ST
DUBUQUE IA
52001-7365
US

IV. Provider business mailing address

1000 LANGWORTHY ST
DUBUQUE IA
52001-7365
US

V. Phone/Fax

Practice location:
  • Phone: 563-584-3450
  • Fax: 563-584-3171
Mailing address:
  • Phone: 563-584-3450
  • Fax: 563-584-3171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberR-10624
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD-48193
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: