Healthcare Provider Details

I. General information

NPI: 1336589548
Provider Name (Legal Business Name): OMER SUHAIB MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2013
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3366 NW EXPRESSWAY STE 200
OKLAHOMA CITY OK
73112
US

IV. Provider business mailing address

5300 N INDEPENDENCE AVE STE 280
OKLAHOMA CITY OK
73112-5555
US

V. Phone/Fax

Practice location:
  • Phone: 405-713-9930
  • Fax: 405-713-9931
Mailing address:
  • Phone: 405-713-9930
  • Fax: 405-713-9931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number2021-01526
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number3719
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number30031
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: