Provider Demographics
NPI:1912370180
Name:OMES, SETH
Entity Type:Individual
Prefix:DR
First Name:SETH
Middle Name:
Last Name:OMES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7505 LARAMIE AVE
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-3346
Mailing Address - Country:US
Mailing Address - Phone:224-615-5734
Mailing Address - Fax:
Practice Address - Street 1:7505 LARAMIE AVE
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-3346
Practice Address - Country:US
Practice Address - Phone:224-715-5734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-09
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070014384225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL225100000XMedicaid
IL225100000XMedicare Oscar/Certification
225100000XMedicare Oscar/Certification
IL225100000XMedicaid
225100000XMedicare UPIN