Healthcare Provider Details

I. General information

NPI: 1861929317
Provider Name (Legal Business Name): OMAR TAMIMI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2017
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2747 CRESCENT ST STE 107
ASTORIA NY
11102-3142
US

IV. Provider business mailing address

7125 ORCHARD LAKE RD STE 120
WEST BLOOMFIELD MI
48322-3627
US

V. Phone/Fax

Practice location:
  • Phone: 866-607-2308
  • Fax:
Mailing address:
  • Phone: 866-607-2308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberS5087
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number340491
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberS5087
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: