Provider Demographics
NPI:1205407194
Name:ROBE, OMAR HASSAN (ACADEMIC DEGREE)
Entity Type:Individual
Prefix:
First Name:OMAR
Middle Name:HASSAN
Last Name:ROBE
Suffix:
Gender:M
Credentials:ACADEMIC DEGREE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1517 88TH AVE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55444-1358
Mailing Address - Country:US
Mailing Address - Phone:612-735-3198
Mailing Address - Fax:
Practice Address - Street 1:1517 88TH AVE N
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55444-1358
Practice Address - Country:US
Practice Address - Phone:612-735-3198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-02
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator