Healthcare Provider Details

I. General information

NPI: 1235824061
Provider Name (Legal Business Name): OMAR SYED NEAMATULLAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2023
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5705 MONCLOVA RD STE 100
MAUMEE OH
43537-1877
US

IV. Provider business mailing address

5705 MONCLOVA RD STE 100
MAUMEE OH
43537-1877
US

V. Phone/Fax

Practice location:
  • Phone: 419-794-2180
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35.155604
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: