Provider Demographics
NPI:1295186492
Name:AIYASH, OMAR
Entity Type:Individual
Prefix:DR
First Name:OMAR
Middle Name:
Last Name:AIYASH
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 1:2020 OGDEN AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-5898
Mailing Address - Country:US
Mailing Address - Phone:630-692-5563
Mailing Address - Fax:630-692-5564
Practice Address - Street 1:2020 OGDEN AVE STE 400
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-5898
Practice Address - Country:US
Practice Address - Phone:630-692-5563
Practice Address - Fax:630-692-5564
Is Sole Proprietor?:No
Enumeration Date:2016-06-29
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036149059207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program