Individual
OMAR DYARA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
959 N MAYFAIR RD, WAUWATOSA, WI 53226-3465
(414) 955-3955
Mailing address
9200 W WISCONSIN AVE, MILWAUKEE, WI 53226-3522
(414) 805-8700
(414) 259-1522
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
20A15228
CA
207L00000X
Anesthesiology Physician
69530
WI
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
69530
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1285077404
—
WI
Enumeration date
04/08/2013
Last updated
08/07/2018
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