MEDICARE: DR. OMER M AKER MD

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	2085R0202X	Diagnostic Radiology Physician	036064832	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

General Provider Information

NPI Number	:	1205821543
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OMER M AKER MD

Provider Business Mailing Address
First Line	:	111 OAKWOOD RD
Second Line	:
City	:	EAST PEORIA
State	:	IL
Zip	:	61611-1853
Country	:	US
Telephone Number	:	309-740-4272
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 E CARPENTER ST
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62769-2413
Country	:	US
Telephone Number	:	217-544-6464
Fax Number	:

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

Provider Enumeration Date	:	09/13/2005
Last Update Date	:	01/11/2024

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