Provider Demographics
NPI:1114190782
Name:BARAKAT, OMAR JASON (MD)
Entity Type:Individual
Prefix:
First Name:OMAR
Middle Name:JASON
Last Name:BARAKAT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5627 S OAK ST
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-5062
Mailing Address - Country:US
Mailing Address - Phone:847-942-1266
Mailing Address - Fax:
Practice Address - Street 1:85 E US HIGHWAY 6
Practice Address - Street 2:DEPARTMENT OF RADIOLOGY
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-8947
Practice Address - Country:US
Practice Address - Phone:219-464-4891
Practice Address - Fax:219-464-1873
Is Sole Proprietor?:No
Enumeration Date:2008-04-03
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO20140087772085R0204X
IN01074595A2085R0204X
IL0361364962085R0204X
MIEMC00047742085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology