Provider Demographics
NPI:1568197390
Name:OMAR, AISHA J (MS)
Entity Type:Individual
Prefix:MS
First Name:AISHA
Middle Name:J
Last Name:OMAR
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:727 S 41ST ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40211-2839
Mailing Address - Country:US
Mailing Address - Phone:502-775-9037
Mailing Address - Fax:
Practice Address - Street 1:727 S 41ST ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40211-2839
Practice Address - Country:US
Practice Address - Phone:502-775-9037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-16
Last Update Date:2022-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty