MEDICARE: OMAR KMALA

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	1223G0001X	General Practice Dentistry	019.036764	IL

General Provider Information

NPI Number	:	1205799046
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OMAR KMALA

Provider Business Mailing Address
First Line	:	7250 S CICERO AVE STE F
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60629-5849
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7250 S CICERO AVE STE F
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60629-5849
Country	:	US
Telephone Number	:	708-496-8896
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 KMALA ” Practice Location

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