Provider Demographics
NPI:1164499307
Name:BAKR, OMAR (MD)
Entity Type:Individual
Prefix:
First Name:OMAR
Middle Name:
Last Name:BAKR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2134 HAMPTON PL
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-3691
Mailing Address - Country:US
Mailing Address - Phone:517-347-3000
Mailing Address - Fax:517-347-8393
Practice Address - Street 1:2134 HAMPTON PL
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-3691
Practice Address - Country:US
Practice Address - Phone:517-347-3000
Practice Address - Fax:517-347-8393
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301050772207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1164499307Medicaid
MI1164499307Medicaid
MI0P27070019Medicare PIN