Provider Demographics
NPI:1154354801
Name:OMAR, IMRAN M (MD)
Entity type:Individual
Prefix:
First Name:IMRAN
Middle Name:M
Last Name:OMAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:676 N SAINT CLAIR ST STE 800
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2978
Mailing Address - Country:US
Mailing Address - Phone:312-695-6732
Mailing Address - Fax:312-695-5645
Practice Address - Street 1:676 N SAINT CLAIR ST STE 800
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2978
Practice Address - Country:US
Practice Address - Phone:312-695-6732
Practice Address - Fax:312-695-5645
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-1158262085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology