Healthcare Provider Details

I. General information

NPI: 1629836929
Provider Name (Legal Business Name): OMAR AHMAD DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2024
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26W171 ROOSEVELT RD
WHEATON IL
60187-6002
US

IV. Provider business mailing address

26W171 ROOSEVELT RD
WHEATON IL
60187-6002
US

V. Phone/Fax

Practice location:
  • Phone: 630-909-7290
  • Fax: 630-909-7291
Mailing address:
  • Phone: 630-909-7290
  • Fax: 630-909-7291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number125.085625
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: