Healthcare Provider Details

I. General information

NPI: 1407824634
Provider Name (Legal Business Name): DR. OMAR A TURK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 01/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4190 24TH AVE SUITE 210
FORT GRATIOT MI
48059
US

IV. Provider business mailing address

4190 24TH AVE STE # 210
FORT GRATIOT MI
48059-3882
US

V. Phone/Fax

Practice location:
  • Phone: 810-216-1901
  • Fax: 810-216-1701
Mailing address:
  • Phone: 810-216-1901
  • Fax: 810-216-1701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number4301080768
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: