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General NPI Number Information
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NPI Number | 1104243336
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Entity Type | Individual
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Provider Name | OMAR METWALLY MD
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Gender | Male
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Dates
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Enumeration Date | 03/26/2014
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Last Update Date | 09/17/2025
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Provider Practice Location Address
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Address Line | 3100 TONGASS AVE
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City | KETCHIKAN
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State | AK
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Zip | 99901-5746
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Country | US
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Telephone | 907-228-8300
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Fax |
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Provider Business Mailing Address
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Address Line | 24224 JOY RD STE 101
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City | REDFORD
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State | MI
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Zip | 48239-1215
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Country | US
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Telephone | 510-437-4141
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 138074
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 226166
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License Number State | AK
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4301114008
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License Number State | MI
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