Healthcare Provider Details

I. General information

NPI: 1679534952
Provider Name (Legal Business Name): OMER QUREISHY MBBS.MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 BRUCE STREET
MARSHALL MN
56258
US

IV. Provider business mailing address

14348 FLORA WAY
APPLE VALLEY MN
55124-3336
US

V. Phone/Fax

Practice location:
  • Phone: 507-537-9300
  • Fax: 507-537-9356
Mailing address:
  • Phone: 952-953-3631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number48196
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: