Provider Demographics
NPI:1255358743
Name:CHEEMA, OMAR MUKHTAR (MD)
Entity type:Individual
Prefix:
First Name:OMAR
Middle Name:MUKHTAR
Last Name:CHEEMA
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 W OKLAHOMA AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-4330
Mailing Address - Country:US
Mailing Address - Phone:414-646-2438
Mailing Address - Fax:
Practice Address - Street 1:2900 W OKLAHOMA AVE FL 4
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-4330
Practice Address - Country:US
Practice Address - Phone:414-646-2438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM8591207R00000X
WI59941207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100027323Medicaid
TX197983301Medicaid
TX197983304Medicaid
TX8AH675OtherBLUE CROSS BLUE SHIELD
MAJ40893OtherBLUE SHIELD
MA2131048Medicaid
TX197983303Medicaid
TXTXB166462Medicare PIN
MAJ40893OtherBLUE SHIELD
TX197983303Medicaid
TX197983304Medicaid
TX258413YKXVMedicare PIN
TX8K8473Medicare PIN