Basic Information
| Provider Information | |||||||||
| NPI: | 1295268258 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SIZAR | ||||||||
| FirstName: | OMEED | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2222 W GRAND RIVER AVE STE A | ||||||||
| Address2: | |||||||||
| City: | OKEMOS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488641604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5173643380 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2222 W GRAND RIVER AVE STE A | ||||||||
| Address2: | |||||||||
| City: | OKEMOS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488641604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5173643380 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2017 | ||||||||
| LastUpdateDate: | 09/27/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | A-2336-20 | NM | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 283140 | MA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 5101026558 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.