Provider Demographics
NPI:1275566051
Name:SANAN, OMER (MD)
Entity Type:Individual
Prefix:
First Name:OMER
Middle Name:
Last Name:SANAN
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 1:2925 CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-1321
Mailing Address - Country:US
Mailing Address - Phone:612-262-5000
Mailing Address - Fax:
Practice Address - Street 1:2635 UNIVERSITY AVE W
Practice Address - Street 2:SUITE 100B
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1270
Practice Address - Country:US
Practice Address - Phone:651-241-9300
Practice Address - Fax:651-241-9285
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN27515208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN820270200Medicaid
MN020003095Medicare PIN
MN820270200Medicaid