Provider Demographics
NPI:1104948991
Name:OMSO MEDICAL LTD
Entity type:Organization
Organization Name:OMSO MEDICAL LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OSCAR
Authorized Official - Middle Name:MAURICIO
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-578-0224
Mailing Address - Street 1:5435 BULL VALLEY RD STE 218
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-7435
Mailing Address - Country:US
Mailing Address - Phone:815-578-0224
Mailing Address - Fax:815-578-0525
Practice Address - Street 1:5435 BULL VALLEY RD
Practice Address - Street 2:SUITE 218
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-7435
Practice Address - Country:US
Practice Address - Phone:815-578-0224
Practice Address - Fax:815-578-0525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36095395207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036095395Medicaid
IL36095395Medicaid
IL212956Medicare ID - Type UnspecifiedMEDICARE PART B
IL036095395Medicaid