Provider Demographics
NPI:1245912070
Name:OMAR, MAHAD
Entity type:Individual
Prefix:
First Name:MAHAD
Middle Name:
Last Name:OMAR
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 1:1865 OLD HUDSON RD STE A14
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55119-4308
Mailing Address - Country:US
Mailing Address - Phone:651-800-1822
Mailing Address - Fax:651-560-3894
Practice Address - Street 1:1865 OLD HUDSON RD STE A14
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55119-4308
Practice Address - Country:US
Practice Address - Phone:651-815-2790
Practice Address - Fax:651-560-3894
Is Sole Proprietor?:No
Enumeration Date:2023-08-02
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor