Healthcare Provider Details

I. General information

NPI: 1518066562
Provider Name (Legal Business Name): OMER SHARIF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 11/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BELOIT MEMORIAL HOSPITAL 1969 W. HART ROAD
BELOIT WI
53511-2230
US

IV. Provider business mailing address

BELOIT HEALTH SYSTEM INC 1905 E. HUEBBE PARKWAY
BELOIT WI
53511-1842
US

V. Phone/Fax

Practice location:
  • Phone: 608-363-5971
  • Fax: 608-363-5737
Mailing address:
  • Phone: 608-364-2293
  • Fax: 608-364-5452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number13916
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number51668-20
License Number StateWI
# 4
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number51668-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: