Provider Demographics
NPI:1396351037
Name:MYNA
Entity type:Organization
Organization Name:MYNA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MANAL
Authorized Official - Middle Name:
Authorized Official - Last Name:OMAR
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:734-716-5901
Mailing Address - Street 1:23647 PADDOCK DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-2227
Mailing Address - Country:US
Mailing Address - Phone:734-716-5901
Mailing Address - Fax:248-658-8777
Practice Address - Street 1:388 INKSTER RD
Practice Address - Street 2:
Practice Address - City:INKSTER
Practice Address - State:MI
Practice Address - Zip Code:48141-1209
Practice Address - Country:US
Practice Address - Phone:734-716-5901
Practice Address - Fax:248-658-8777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-18
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care