MEDICARE: CHRISTOPHER OMERZA M.D.

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
1	208600000X	Surgery Physician	R-10624	IA
2	208600000X	Surgery Physician	MD-48193	IA

General Provider Information

NPI Number	:	1063862712
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER OMERZA M.D.

Provider Business Mailing Address
First Line	:	1414 W FAIR AVE STE 230
Second Line	:
City	:	MARQUETTE
State	:	MI
Zip	:	49855-5409
Country	:	US
Telephone Number	:	906-449-1666
Fax Number	:

Provider Business Practice Location Address
First Line	:	1414 W FAIR AVE STE 230
Second Line	:
City	:	MARQUETTE
State	:	MI
Zip	:	49855-5409
Country	:	US
Telephone Number	:	906-449-1666
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2016
Last Update Date	:	05/05/2026

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