Provider Demographics
NPI:1548938053
Name:OMAR, UMAL-KHAYR ABDIRAHMAN
Entity type:Individual
Prefix:
First Name:UMAL-KHAYR
Middle Name:ABDIRAHMAN
Last Name:OMAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12031 TERRACE CT NE
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55434-3384
Mailing Address - Country:US
Mailing Address - Phone:612-806-7860
Mailing Address - Fax:
Practice Address - Street 1:12031 TERRACE CT NE
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55434-3384
Practice Address - Country:US
Practice Address - Phone:612-806-7860
Practice Address - Fax:612-278-2110
Is Sole Proprietor?:No
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program