Healthcare Provider Details

I. General information

NPI: 1437129095
Provider Name (Legal Business Name): DAVID L OHMART M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

670 MALL DR
PORTAGE MI
49024-2878
US

IV. Provider business mailing address

670 MALL DR
PORTAGE MI
49024-2878
US

V. Phone/Fax

Practice location:
  • Phone: 269-327-1900
  • Fax: 269-327-1564
Mailing address:
  • Phone: 269-327-1900
  • Fax: 269-327-1564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberDO037883
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: