Individual
OMAR ILYAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
555 E CHEVES ST, FLORENCE, SC 29506-2617
(843) 777-2000
Mailing address
555 E CHEVES ST, FLORENCE, SC 29506-2617
(843) 777-2000
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
82372
SC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/13/2016
Last updated
01/29/2020
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