Healthcare Provider Details

I. General information

NPI: 1326422528
Provider Name (Legal Business Name): OMER ZAMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2015
Last Update Date: 07/02/2021
Certification Date: 07/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 OAKWOOD BLVD
DEARBORN MI
48124-2319
US

IV. Provider business mailing address

840 OAKWOOD BLVD
DEARBORN MI
48124-2319
US

V. Phone/Fax

Practice location:
  • Phone: 313-359-7600
  • Fax: 313-359-7678
Mailing address:
  • Phone: 313-359-7600
  • Fax: 313-359-7678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number4301504741
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number4301504741
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number5315070413
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: