Healthcare Provider Details

I. General information

NPI: 1548260037
Provider Name (Legal Business Name): OMEGA S PARIL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 06/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2610 DAVISON RD
FLINT MI
48506-3651
US

IV. Provider business mailing address

2610 DAVISON RD
FLINT MI
48506-3651
US

V. Phone/Fax

Practice location:
  • Phone: 810-233-6938
  • Fax: 810-233-3552
Mailing address:
  • Phone: 810-233-6938
  • Fax: 810-233-3552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number038544
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: