Provider Demographics
NPI:1538200308
Name:MEMAR, OMEED (MD)
Entity type:Individual
Prefix:
First Name:OMEED
Middle Name:
Last Name:MEMAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 809397
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60680-9397
Mailing Address - Country:US
Mailing Address - Phone:312-230-0180
Mailing Address - Fax:312-230-0181
Practice Address - Street 1:50 E WASHINGTON ST STE 200
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-2154
Practice Address - Country:US
Practice Address - Phone:312-230-0180
Practice Address - Fax:312-230-0181
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL336061711207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILH06507Medicare UPIN
201628Medicare PIN
201628Medicare ID - Type Unspecified