Provider Demographics
NPI:1851371231
Name:BADAHMAN, OMER M (MD)
Entity Type:Individual
Prefix:
First Name:OMER
Middle Name:M
Last Name:BADAHMAN
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 1:4600 MEMORIAL DR STE 200
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62226-5363
Mailing Address - Country:US
Mailing Address - Phone:618-233-2220
Mailing Address - Fax:
Practice Address - Street 1:4600 MEMORIAL DR STE 200
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62226-5363
Practice Address - Country:US
Practice Address - Phone:618-233-2220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036102100207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036102100Medicaid
IL01932056OtherBCBS OF IL
P00388512Medicare PIN
IL036102100Medicaid
211289Medicare PIN
H35380Medicare UPIN