Healthcare Provider Details

I. General information

NPI: 1255398764
Provider Name (Legal Business Name): OMAR A MAJID M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 12/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18101 OAKWOOD BLVD RADIATION ONCOLOGY DEPT
DEARBORN MI
48124-4089
US

IV. Provider business mailing address

PO BOX 33016
BLOOMFIELD HILLS MI
48303-3016
US

V. Phone/Fax

Practice location:
  • Phone: 313-593-7338
  • Fax: 313-593-8844
Mailing address:
  • Phone: 313-593-7338
  • Fax: 313-593-8844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number4301047912
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number4301047912
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: