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General NPI Number Information
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NPI Number | 1609163013
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Entity Type | Individual
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Provider Name | OMAR ABDULJABAR ALYAMANI M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/06/2011
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Last Update Date | 08/22/2018
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Provider Practice Location Address
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Address Line | 3990 JOHN R ST BOX 162
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City | DETROIT
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State | MI
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Zip | 48201
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Country | US
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Telephone | 313-745-7233
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Fax | 313-993-3889
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Provider Business Mailing Address
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Address Line | 1407 SHORE CLUB DR
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City | SAINT CLAIR SHORES
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State | MI
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Zip | 48080-1566
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Country | US
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Telephone | 312-646-9094
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | D82452
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License Number State | MD
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