Healthcare Provider Details

I. General information

NPI: 1497286827
Provider Name (Legal Business Name): DANLY OSMARY OMIL-LIMA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2017
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7500 FRANCE AVE S
EDINA MN
55435-3400
US

IV. Provider business mailing address

3001 METRO DR STE 460
BLOOMINGTON MN
55425-1548
US

V. Phone/Fax

Practice location:
  • Phone: 952-927-6501
  • Fax: 833-905-0988
Mailing address:
  • Phone: 952-927-6501
  • Fax: 833-905-0988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number79574
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: