Provider Demographics
NPI:1538398946
Name:PEREZ, OMAR M (MD)
Entity type:Individual
Prefix:DR
First Name:OMAR
Middle Name:M
Last Name:PEREZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:OMAR
Other - Middle Name:M
Other - Last Name:PEREZ-CARILLO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:9445 CALUMET AVE
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-2811
Mailing Address - Country:US
Mailing Address - Phone:219-836-1060
Mailing Address - Fax:219-836-1014
Practice Address - Street 1:9445 CALUMET AVE
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2811
Practice Address - Country:US
Practice Address - Phone:219-836-1060
Practice Address - Fax:219-836-1014
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-07
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
IN01077396A207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1538398946OtherNPI