Provider Demographics
NPI:1366833204
Name:UDDIN, OMAR MINHAJ (MD)
Entity Type:Individual
Prefix:DR
First Name:OMAR
Middle Name:MINHAJ
Last Name:UDDIN
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 1:1725 W HARRISON ST STE 450
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-4828
Mailing Address - Country:US
Mailing Address - Phone:312-942-4184
Mailing Address - Fax:312-942-7244
Practice Address - Street 1:1725 W HARRISON ST STE 450
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612
Practice Address - Country:US
Practice Address - Phone:312-942-4184
Practice Address - Fax:312-942-7244
Is Sole Proprietor?:No
Enumeration Date:2015-02-13
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.0727112085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology