Provider Demographics
NPI:1841972163
Name:WEHELIYE, OMAR
Entity type:Individual
Prefix:
First Name:OMAR
Middle Name:
Last Name:WEHELIYE
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 1:6501 WATTS RD STE 134B
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-1391
Mailing Address - Country:US
Mailing Address - Phone:608-421-8307
Mailing Address - Fax:
Practice Address - Street 1:6501 WATTS RD STE 134B
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-1391
Practice Address - Country:US
Practice Address - Phone:608-421-8307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-04
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver