Provider Demographics
NPI:1154555001
Name:OMAR, FEISAL KOWLE
Entity type:Individual
Prefix:
First Name:FEISAL
Middle Name:KOWLE
Last Name:OMAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 E 24TH ST
Mailing Address - Street 2:C115
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-3869
Mailing Address - Country:US
Mailing Address - Phone:612-644-7896
Mailing Address - Fax:
Practice Address - Street 1:912 E 24TH ST
Practice Address - Street 2:C115
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-3869
Practice Address - Country:US
Practice Address - Phone:612-644-7896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-06
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN9950510OtherMINNESOTACARE