Basic Information
| Provider Information | |||||||||
| NPI: | 1962897264 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HORANI | ||||||||
| FirstName: | OMAR | ||||||||
| MiddleName: | NABIL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | AL-HOURANI | ||||||||
| OtherFirstName: | OMAR | ||||||||
| OtherMiddleName: | NABIL | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 4510 DORR ST # MS 840 | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436154040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4193833811 | ||||||||
| FaxNumber: | 4193832918 | ||||||||
| Practice Location | |||||||||
| Address1: | 3000 ARLINGTON AVE | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43614 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4193833829 | ||||||||
| FaxNumber: | 4193832918 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2015 | ||||||||
| LastUpdateDate: | 06/16/2020 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 06/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD189133 | OR | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 35.133434 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 4301107990 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | MD469850 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 01083397A | IN | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0301735 | 05 | OH | MEDICAID |