Healthcare Provider Details

I. General information

NPI: 1538256227
Provider Name (Legal Business Name): OMAR ADEL OMAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 12/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10701 EAST BLVD
CLEVELAND OH
44106-1702
US

IV. Provider business mailing address

31011 LOGAN CT
WESTLAKE OH
44145-6832
US

V. Phone/Fax

Practice location:
  • Phone: 216-791-3800
  • Fax: 216-707-5905
Mailing address:
  • Phone: 440-835-0825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number35.082082
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number35082082
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: