MEDICARE: MR. AHMED ALI 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	207R00000X	Internal Medicine Physician	48513	MN

General Provider Information

NPI Number	:	1356312722
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. AHMED ALI OMAR M.D.

Provider Business Mailing Address
First Line	:	9875 HOSPITAL DR
Second Line	:	SUITE 3009
City	:	MAPLE GROVE
State	:	MN
Zip	:	55369-4648
Country	:	US
Telephone Number	:	763-581-1370
Fax Number	:	763-581-3007

Provider Business Practice Location Address
First Line	:	9875 HOSPITAL DR
Second Line	:	SUITE 3009
City	:	MAPLE GROVE
State	:	MN
Zip	:	55369-4648
Country	:	US
Telephone Number	:	763-581-1370
Fax Number	:	763-581-3007

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

Provider Enumeration Date	:	02/01/2006
Last Update Date	:	02/04/2014

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