=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598022725
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | OMAR NADHEM M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/12/2012
-----------------------------------------------------
Last Update Date | 07/29/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2901 NORTH CENTRAL AVENUE
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-502-1900
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2901 NORTH CENTRAL AVENUE SUITE 160
-----------------------------------------------------
City | PHEONIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-828-4060
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | 0116030678
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------