Healthcare Provider Details

I. General information

NPI: 1346826229
Provider Name (Legal Business Name): OMAR ALZARKALI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2021
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 MICHIGAN ST NE STE 2200
GRAND RAPIDS MI
49503-2562
US

IV. Provider business mailing address

145 MICHIGAN ST NE STE 2200
GRAND RAPIDS MI
49503-2562
US

V. Phone/Fax

Practice location:
  • Phone: 616-486-5933
  • Fax: 616-486-5392
Mailing address:
  • Phone: 616-486-5933
  • Fax: 616-486-5392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number5101029376
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: