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General NPI Number Information
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NPI Number | 1629751466
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Entity Type | Organization
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Legal Business Name | OMNI MEDICAL GROUP, PLLC
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Dates
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Enumeration Date | 08/09/2023
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Last Update Date | 11/06/2025
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Provider Practice Location Address
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Address Line | 7431 N UNIVERSITY DR STE 200
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City | TAMARAC
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State | FL
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Zip | 33321-2956
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Country | US
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Telephone | 954-551-4849
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Fax |
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Provider Business Mailing Address
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Address Line | 7431 N UNIVERSITY DR STE 200
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City | TAMARAC
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State | FL
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Zip | 33321-2956
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Country | US
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Telephone | 954-551-4849
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Fax | 954-952-0352
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Authorized Official
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Title or Position | CEO, PHYSICIAN
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Name | DR. JOHN B PASSANTINO
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Credential | MD
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Telephone | 954-495-0771
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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