Provider Demographics
NPI:1538542337
Name:OLIVEROS, OMAR ALBERTO (MD)
Entity type:Individual
Prefix:
First Name:OMAR
Middle Name:ALBERTO
Last Name:OLIVEROS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:OMAR
Other - Middle Name:ALBERTO
Other - Last Name:OLIVEROS PADRON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 746715
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6715
Mailing Address - Country:US
Mailing Address - Phone:773-377-7736
Mailing Address - Fax:815-642-5723
Practice Address - Street 1:4417 W DIVERSEY AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60639-1923
Practice Address - Country:US
Practice Address - Phone:773-377-7736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-30
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036146049207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine