Provider Demographics
NPI:1407824634
Name:TURK, OMAR A
Entity Type:Individual
Prefix:DR
First Name:OMAR
Middle Name:A
Last Name:TURK
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 1:4190 24TH AVE
Mailing Address - Street 2:STE # 210
Mailing Address - City:FORT GRATIOT
Mailing Address - State:MI
Mailing Address - Zip Code:48059-3882
Mailing Address - Country:US
Mailing Address - Phone:810-216-1901
Mailing Address - Fax:810-216-1701
Practice Address - Street 1:4190 24TH AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:FORT GRATIOT
Practice Address - State:MI
Practice Address - Zip Code:48059
Practice Address - Country:US
Practice Address - Phone:810-216-1901
Practice Address - Fax:810-216-1701
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010807682084N0400X, 2084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2650715Medicaid
OH000000391367OtherANTHEM
MI1308205442OtherBCBS OF MICHIGAN
OH2650715Medicaid
I50681Medicare UPIN
OH000000391367OtherANTHEM
MI0A37669Medicare PIN