Basic Information
Provider Information
NPI: 1861773491
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: OMRAN
FirstName: QASIM
MiddleName: M
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5900 BYRON CENTER AVE SW
Address2: MEDICAL ADMINISTRATION
City: WYOMING
State: MI
PostalCode: 495199606
CountryCode: US
TelephoneNumber: 6162523243
FaxNumber: 6162520260
Practice Location
Address1: 2122 HEALTH DR SW
Address2:  
City: WYOMING
State: MI
PostalCode: 49519
CountryCode: US
TelephoneNumber: 6162525220
FaxNumber: 6162525770
Other Information
ProviderEnumerationDate: 09/09/2011
LastUpdateDate: 05/15/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RC0200X4301075275MIN Allopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
207RG0100X4301075275MIN Allopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
207RS0012X4301075275MIN Allopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
207RP1001X4301075275MIY Allopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease

No ID Information.


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