Basic Information
| Provider Information | |||||||||
| NPI: | 1982015681 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BIBI | ||||||||
| FirstName: | OMAR | ||||||||
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| Credential: | MD, MBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 810 SAINT VINCENTS DR | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352051601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059302456 | ||||||||
| FaxNumber: | 2059302469 | ||||||||
| Practice Location | |||||||||
| Address1: | 810 SAINT VINCENTS DR | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352051601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059302456 | ||||||||
| FaxNumber: | 2059302469 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2014 | ||||||||
| LastUpdateDate: | 02/08/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD.38251 | AL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 324869 | LA | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 324869 | 01 | LA | STATE LICENSE | OTHER |