Provider Demographics
NPI:1356312722
Name:OMAR, AHMED ALI (MD)
Entity Type:Individual
Prefix:MR
First Name:AHMED
Middle Name:ALI
Last Name:OMAR
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Gender:M
Credentials:MD
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Mailing Address - Street 1:9875 HOSPITAL DR
Mailing Address - Street 2:SUITE 3009
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-4648
Mailing Address - Country:US
Mailing Address - Phone:763-581-1370
Mailing Address - Fax:763-581-3007
Practice Address - Street 1:9875 HOSPITAL DR
Practice Address - Street 2:SUITE 3009
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-4648
Practice Address - Country:US
Practice Address - Phone:763-581-1370
Practice Address - Fax:763-581-3007
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2014-02-04
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Provider Licenses
StateLicense IDTaxonomies
MN48513207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNH83978Medicare UPIN