Provider Demographics
NPI:1225720709
Name:OMAR, ABDULGABAR
Entity Type:Individual
Prefix:
First Name:ABDULGABAR
Middle Name:
Last Name:OMAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29103 BARKLEY ST
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-4005
Mailing Address - Country:US
Mailing Address - Phone:313-415-1381
Mailing Address - Fax:
Practice Address - Street 1:29103 BARKLEY ST
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-4005
Practice Address - Country:US
Practice Address - Phone:313-415-1381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes342000000XTransportation ServicesTransportation Network Company