MEDICARE: DR. TARIQ OMAR 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	207RP1001X	Pulmonary Disease Physician	4301070276	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	TO070276	OTHER	MI	BLUE CROSS LICENSE #
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144208174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TARIQ OMAR M.D.

Provider Business Mailing Address
First Line	:	PO BOX 673968
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48267-0001
Country	:	US
Telephone Number	:	734-462-0340
Fax Number	:	734-462-0344

Provider Business Practice Location Address
First Line	:	26245 SOUTHFIELD RD
Second Line	:
City	:	LATHRUP VILLAGE
State	:	MI
Zip	:	48076-4546
Country	:	US
Telephone Number	:	248-327-7634
Fax Number	:	248-327-7641

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

Provider Enumeration Date	:	01/09/2006
Last Update Date	:	01/07/2014

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