Basic Information
| Provider Information | |||||||||
| NPI: | 1881989853 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DIMACHKIEH | ||||||||
| FirstName: | OMAR | ||||||||
| MiddleName: | SAAD | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6400 FANNIN ST STE 1700 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770301526 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7135007500 | ||||||||
| FaxNumber: | 7135122234 | ||||||||
| Practice Location | |||||||||
| Address1: | 9305 PINECROFT DR STE 400 | ||||||||
| Address2: | |||||||||
| City: | THE WOODLANDS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773803482 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134868800 | ||||||||
| FaxNumber: | 2813671323 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2011 | ||||||||
| LastUpdateDate: | 10/30/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XS0106X | R2576 | TX | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Hand Surgery | 207XS0106X | DR.0056809 | CO | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Hand Surgery |
ID Information
| ID | Type | State | Issuer | Description | 8GT762 | 01 | TX | BLUE CROSS BLUE SHIELD | OTHER | 373460001 | 05 | TX | MEDICAID |