Provider Demographics
NPI:1962450999
Name:SUAREZ, OMAR D (MD)
Entity Type:Individual
Prefix:DR
First Name:OMAR
Middle Name:D
Last Name:SUAREZ
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 1:2050 NE 163RD ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-4903
Mailing Address - Country:US
Mailing Address - Phone:305-947-7133
Mailing Address - Fax:305-947-7188
Practice Address - Street 1:4125 W 20TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-5874
Practice Address - Country:US
Practice Address - Phone:305-424-3120
Practice Address - Fax:305-424-3182
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME84847208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL264190900Medicaid
FL264190900Medicaid
FLH67964Medicare UPIN