Organization
DR O MD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. OMAR L DOMINIQUE MD (PRESIDENT)
(480) 770-3967
Entity
Organization
Contact information
Practice address
7828 S HOYNE AVE, CHICAGO, IL 60620-5741
(480) 770-3967
Mailing address
7828 S HOYNE AVE, CHICAGO, IL 60620-5741
(480) 770-3967
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
02/18/2020
Last updated
06/25/2020
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