Provider Demographics
NPI:1760656151
Name:BATAL, OMAR ABDULHAMID (MD)
Entity Type:Individual
Prefix:
First Name:OMAR
Middle Name:ABDULHAMID
Last Name:BATAL
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 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1111 N RONALD REAGAN PARKWAY
Practice Address - Street 2:SUITE 171
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-6910
Practice Address - Country:US
Practice Address - Phone:317-944-5330
Practice Address - Fax:317-273-5988
Is Sole Proprietor?:No
Enumeration Date:2008-04-16
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57-012978207R00000X
IN01073926A207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201227480Medicaid
INP01355188Medicare PIN
IN183380016Medicare PIN
IN201227480Medicaid