MEDICARE: MYNA

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	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1396351037
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MYNA

Provider Business Mailing Address
First Line	:	23647 PADDOCK DR
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48336-2227
Country	:	US
Telephone Number	:	734-716-5901
Fax Number	:	248-658-8777

Provider Business Practice Location Address
First Line	:	388 INKSTER RD
Second Line	:
City	:	INKSTER
State	:	MI
Zip	:	48141-1209
Country	:	US
Telephone Number	:	734-716-5901
Fax Number	:	248-658-8777

Authorized Official
Title or Position	:	PHYSICIAN/OWNER
Name	:	MANAL OMAR
Credential	:	DO
Telephone Number	:	734-716-5901

Provider Enumeration Date	:	09/18/2020
Last Update Date	:	05/24/2021

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Directions to “MYNA ” Practice Location

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