Provider Demographics
NPI:1063710523
Name:FATEMA OMRAN MD PC
Entity type:Organization
Organization Name:FATEMA OMRAN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FATEMA
Authorized Official - Middle Name:
Authorized Official - Last Name:OMRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-687-9747
Mailing Address - Street 1:8081 COMMERCE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:COMMERCE TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48382-3595
Mailing Address - Country:US
Mailing Address - Phone:248-363-3215
Mailing Address - Fax:
Practice Address - Street 1:8081 COMMERCE RD
Practice Address - Street 2:SUITE A
Practice Address - City:COMMERCE TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48382-3595
Practice Address - Country:US
Practice Address - Phone:248-363-3215
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-08
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty