Provider Demographics
NPI:1154467553
Name:QUILES, OMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:OMAR
Middle Name:
Last Name:QUILES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:OMAR
Other - Middle Name:
Other - Last Name:QUILES-QUINTERO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 420037
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34742-0037
Mailing Address - Country:US
Mailing Address - Phone:321-442-8009
Mailing Address - Fax:321-442-8012
Practice Address - Street 1:601 S SEMORAN BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-3120
Practice Address - Country:US
Practice Address - Phone:321-442-8009
Practice Address - Fax:321-442-8012
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1019562081P2900X, 208VP0014X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME101956OtherFLORIDA LICENSE
FLAV465UMedicare PIN