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Individual

DR. OMAR S OBEIDAT

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1801 N SENATE BLVD, STE 310, INDIANAPOLIS, IN 46202-1196
(317) 962-2500
(317) 962-2515
Mailing address
250 N SHADELAND AVE, STE 130 PROVIDER ENROLLMENT, INDIANAPOLIS, IN 46219-4959

Taxonomy

Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
01056864A
IN
207RC0000X
Cardiovascular Disease Physician
MD458745
PA
207RI0011X
Interventional Cardiology Physician
Primary
01056864A
IN
207RI0011X
Interventional Cardiology Physician
MD458745
PA
207UN0901X
Nuclear Cardiology Physician
01056864
IN
207UN0901X
Nuclear Cardiology Physician
MD458745
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200450740
IN
01
P01092952
RAILROAD MEDICARE PIN
IN
Enumeration date
02/14/2006
Last updated
08/24/2016
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