MEDICARE: OMAR ELZOOBI

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	3747P1801X	Personal Care Attendant	MI
2	376J00000X	Homemaker	MI
3	251E00000X	Home Health Agency	MI

General Provider Information

NPI Number	:	1134082019
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OMAR ELZOOBI

Provider Business Mailing Address
First Line	:	4001 LINCOLN BLVD
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48125-2551
Country	:	US
Telephone Number	:	313-674-0172
Fax Number	:

Provider Business Practice Location Address
First Line	:	4001 LINCOLN BLVD
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48125-2551
Country	:	US
Telephone Number	:	313-674-0172
Fax Number	:

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

Provider Enumeration Date	:	12/08/2025
Last Update Date	:	12/08/2025

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Directions to “ OMAR ELZOOBI ” Practice Location

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