Individual
AHMED KHALID AL-OMARI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
350 W 11TH ST RM 4040, INDIANAPOLIS, IN 46202-4108
(317) 491-6355
(317) 491-6334
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207ZD0900X
Dermatopathology (Pathology) Physician
01077395A
IN
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
01077395A
IN
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
CSP0050443
CT
208600000X
Surgery Physician
4301096192
MI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001053403
ANTHEM PTAN
IN
Enumeration date
08/22/2010
Last updated
05/08/2025
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