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General NPI Number Information
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NPI Number | 1245896034
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Entity Type | Individual
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Provider Name | IBRAHIM DARE OMORE M.D
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Gender | Male
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Dates
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Enumeration Date | 05/16/2019
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Last Update Date | 08/07/2025
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Provider Practice Location Address
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Address Line | 1400 PIN OAK DR
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City | CARTERVILLE
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State | IL
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Zip | 62918-1600
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Country | US
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Telephone | 618-985-3333
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Fax | 618-985-1318
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Provider Business Mailing Address
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Address Line | PO BOX 3988
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City | CARBONDALE
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State | IL
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Zip | 62902-3988
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Country | US
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Telephone | 618-457-5200
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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 | 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 #2
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 036172695
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License Number State | IL
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