Provider Demographics
NPI:1285322271
Name:OMAR, SAMIRA SUFI I (PROVIDER)
Entity type:Individual
Prefix:MS
First Name:SAMIRA
Middle Name:SUFI
Last Name:OMAR
Suffix:I
Gender:F
Credentials:PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11245 LANTERN RD APT 222
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-3219
Mailing Address - Country:US
Mailing Address - Phone:317-665-2790
Mailing Address - Fax:
Practice Address - Street 1:11245 LANTERN RD APT 222
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-3219
Practice Address - Country:US
Practice Address - Phone:317-665-2790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-27
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)