Individual
ELLEN C OMI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4400 W 95TH ST, OAK LAWN, IL 60453-2654
(708) 684-8000
Mailing address
4400 W 95TH ST, OAK LAWN, IL 60453-2654
(708) 684-8000
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
036114622
IL
2086S0102X
Surgical Critical Care Physician
036114622
IL
2086S0127X
Trauma Surgery Physician
Primary
036114622
IL
Other
Enumeration date
07/12/2006
Last updated
11/10/2009
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