Provider Demographics
NPI:1356607626
Name:OMER, ABDEL RAHMAN ABUOBIEDA (MD)
Entity type:Individual
Prefix:
First Name:ABDEL RAHMAN
Middle Name:ABUOBIEDA
Last Name:OMER
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 1:1000 E PARIS AVE SE STE 200
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-8383
Mailing Address - Country:US
Mailing Address - Phone:616-685-3450
Mailing Address - Fax:
Practice Address - Street 1:1000 E PARIS AVE SE STE 200
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-8383
Practice Address - Country:US
Practice Address - Phone:616-685-3450
Practice Address - Fax:616-685-3454
Is Sole Proprietor?:No
Enumeration Date:2012-04-11
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301505377207RI0011X, 207RC0000X
PAMT212642207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX347921401Medicaid
TX347921402Medicaid
OK200589870 AMedicaid
NM67577016Medicaid
TX347921402Medicaid