Individual
OMAR KHAYYAM JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
HFA
Contact information
Practice address
2735 ROTHE LN, INDIANAPOLIS, IN 46229-5517
(317) 540-4294
(317) 434-5908
Mailing address
2735 ROTHE LN, INDIANAPOLIS, IN 46229-5517
(317) 540-4294
(317) 434-5908
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
14002332A
IN
Other
Enumeration date
06/12/2019
Last updated
06/12/2019
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