Healthcare Provider Details

I. General information

NPI: 1942225511
Provider Name (Legal Business Name): OMMAR T HLA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 11/03/2021
Certification Date: 11/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 W US ROUTE 6
MORRIS IL
60450
US

IV. Provider business mailing address

725 SCHOOL ST STE A
MORRIS IL
60450-1207
US

V. Phone/Fax

Practice location:
  • Phone: 815-364-8915
  • Fax: 815-941-0743
Mailing address:
  • Phone: 815-941-9124
  • Fax: 815-941-4363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberG158948
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number036091671
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: