Provider Demographics
NPI:1174539464
Name:ABID, OMER (MD)
Entity type:Individual
Prefix:
First Name:OMER
Middle Name:
Last Name:ABID
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 1:1820 RIDGE RD
Mailing Address - Street 2:STE 102
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-1760
Mailing Address - Country:US
Mailing Address - Phone:708-647-7550
Mailing Address - Fax:
Practice Address - Street 1:1820 RIDGE RD
Practice Address - Street 2:STE 102
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-1760
Practice Address - Country:US
Practice Address - Phone:708-647-7550
Practice Address - Fax:708-647-7564
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2008-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361148722083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036114872Medicaid
IL036114872Medicaid
ILK52288Medicare PIN