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General NPI Number Information
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NPI Number | 1598224677
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Entity Type | Individual
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Provider Name | OMAR I FIDA MD
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Gender | Male
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Dates
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Enumeration Date | 03/18/2019
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Last Update Date | 09/03/2024
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Provider Practice Location Address
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Address Line | 251 E HURON ST STE 16-738
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City | CHICAGO
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State | IL
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Zip | 60611-3055
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Country | US
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Telephone | 312-926-5924
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Fax | 312-926-6134
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Provider Business Mailing Address
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Address Line | 6850 LAKE NONA BLVD
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City | ORLANDO
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State | FL
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Zip | 32827-7408
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Country | US
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Telephone | 407-266-1106
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Fax | 407-518-3923
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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 | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 036171353
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | TRN28410
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License Number State | FL
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