Provider Demographics
NPI:1184916991
Name:EDWARD OMRON, M.D., INC.
Entity type:Organization
Organization Name:EDWARD OMRON, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:OMRON
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH
Authorized Official - Phone:408-778-0022
Mailing Address - Street 1:18525 SUTTER BLVD
Mailing Address - Street 2:SUITE 180
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037-8100
Mailing Address - Country:US
Mailing Address - Phone:408-778-0022
Mailing Address - Fax:
Practice Address - Street 1:18525 SUTTER BLVD
Practice Address - Street 2:SUITE 180
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037-8100
Practice Address - Country:US
Practice Address - Phone:408-778-0022
Practice Address - Fax:408-778-0055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-12
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA105179207RC0200X, 207RP1001X
MI4301069097207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4718594Medicaid
MIN15080007Medicare UPIN