Provider Demographics
NPI:1679534952
Name:QUREISHY, OMER (MBBSMD)
Entity Type:Individual
Prefix:DR
First Name:OMER
Middle Name:
Last Name:QUREISHY
Suffix:
Gender:M
Credentials:MBBSMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14348 FLORA WAY
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-3336
Mailing Address - Country:US
Mailing Address - Phone:952-953-3631
Mailing Address - Fax:
Practice Address - Street 1:300 BRUCE STREET
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MN
Practice Address - Zip Code:56258
Practice Address - Country:US
Practice Address - Phone:507-537-9300
Practice Address - Fax:507-537-9356
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN48196208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN264P4QUOtherBLUE CROSS PROVIDER
MN722646200Medicaid
MN722646200Medicaid
MN264P4QUOtherBLUE CROSS PROVIDER