MEDICARE: OMSO MEDICAL LTD

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	207R00000X	Internal Medicine Physician	36095395	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104948991
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OMSO MEDICAL LTD

Provider Business Mailing Address
First Line	:	5435 BULL VALLEY RD STE 218
Second Line	:
City	:	MCHENRY
State	:	IL
Zip	:	60050-7435
Country	:	US
Telephone Number	:	815-578-0224
Fax Number	:	815-578-0525

Provider Business Practice Location Address
First Line	:	5435 BULL VALLEY RD
Second Line	:	SUITE 218
City	:	MCHENRY
State	:	IL
Zip	:	60050-7435
Country	:	US
Telephone Number	:	815-578-0224
Fax Number	:	815-578-0525

Authorized Official
Title or Position	:	PRESIDENT
Name	:	OSCAR MAURICIO SANCHEZ
Credential	:	MD
Telephone Number	:	815-578-0224

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	01/25/2023

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Directions to “OMSO MEDICAL LTD ” Practice Location

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