Provider Demographics
NPI:1497867873
Name:GUIMARAES, OMAR F S (MD)
Entity Type:Individual
Prefix:
First Name:OMAR
Middle Name:F S
Last Name:GUIMARAES
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 1:24 MORRIS ROAD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SHELBY
Mailing Address - State:OH
Mailing Address - Zip Code:44875-1152
Mailing Address - Country:US
Mailing Address - Phone:419-342-2900
Mailing Address - Fax:419-342-2902
Practice Address - Street 1:24 MORRIS ROAD
Practice Address - Street 2:SUITE 3
Practice Address - City:SHELBY
Practice Address - State:OH
Practice Address - Zip Code:44875-1152
Practice Address - Country:US
Practice Address - Phone:419-342-2900
Practice Address - Fax:419-342-2902
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-06-9007207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0172629Medicaid
OH0172629Medicaid
OH0874231Medicare PIN