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NPI Code Detail

MEDICARE: IKRAM OMAR

MEDICARE: IKRAM OMAR
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1013642545
Entity Type Code : Individual
Provider Name (Legal Business Name) : IKRAM OMAR
Provider Business Mailing Address
First Line : 706 ROBERT ST S
Second Line :
City : SAINT PAUL
State : MN
Zip : 55107-2948
Country : US
Telephone Number : 651-330-3331
Fax Number :
Provider Business Practice Location Address
First Line : 706 ROBERT ST S
Second Line :
City : SAINT PAUL
State : MN
Zip : 55107-2948
Country : US
Telephone Number : 195-239-3793
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/19/2022
Last Update Date : 07/19/2022

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Directions to “ IKRAM OMAR ” Practice Location

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