Provider Demographics
NPI:1942225511
Name:HLA, OMMAR T (MD)
Entity Type:Individual
Prefix:
First Name:OMMAR
Middle Name:T
Last Name:HLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 SCHOOL ST STE A
Mailing Address - Street 2:
Mailing Address - City:MORRIS
Mailing Address - State:IL
Mailing Address - Zip Code:60450-1207
Mailing Address - Country:US
Mailing Address - Phone:815-941-9124
Mailing Address - Fax:815-941-4363
Practice Address - Street 1:1600 W US ROUTE 6
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:IL
Practice Address - Zip Code:60450
Practice Address - Country:US
Practice Address - Phone:815-364-8915
Practice Address - Fax:815-941-0743
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG1589482085R0001X
IL0360916712085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036091671 1Medicaid
IL214143OtherLUDAG-JOLIET
IL214152OtherLUDAG-KANKAKEE
IL209405012OtherMEDICARE-COOK NOMC
ILK31484OtherMEDICARE JOLIET
ILP00348399OtherRAIL ROAD MEDICARE
IL09919437OtherJOHA BCBS
IL8232230OtherBLUE CROSS BLUE SHIELD
ILK33087OtherMEDICARE-KANKAKEE
ILK48414OtherMEDICARE INDIV ID# FOR GROUP 336140
IN000000503203OtherANTHEM
IL749640013OtherMEDICARE-WILL NOSC
IL749640013OtherMEDICARE-WILL NOSC
IL8232230OtherBLUE CROSS BLUE SHIELD