Individual
DR. TARIQ OMAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
26245 SOUTHFIELD RD, LATHRUP VILLAGE, MI 48076-4546
(248) 327-7634
(248) 327-7641
Mailing address
PO BOX 673968, DETROIT, MI 48267-0001
(734) 462-0340
(734) 462-0344
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
4301070276
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104501587
—
MI
01
—
TO070276
BLUE CROSS LICENSE #
MI
Enumeration date
01/09/2006
Last updated
01/07/2014
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