Provider Demographics
NPI:1134172091
Name:OHMART, GALEN DONALD (MD)
Entity type:Individual
Prefix:
First Name:GALEN
Middle Name:DONALD
Last Name:OHMART
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 1:2079 S STATE AVE
Mailing Address - Street 2:
Mailing Address - City:ALPENA
Mailing Address - State:MI
Mailing Address - Zip Code:49707-4524
Mailing Address - Country:US
Mailing Address - Phone:989-354-2191
Mailing Address - Fax:989-356-0784
Practice Address - Street 1:2079 S STATE AVE
Practice Address - Street 2:
Practice Address - City:ALPENA
Practice Address - State:MI
Practice Address - Zip Code:49707-4524
Practice Address - Country:US
Practice Address - Phone:989-354-2191
Practice Address - Fax:989-356-0784
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301025244207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0044951Medicare ID - Type Unspecified
MIB46587Medicare UPIN