| Omni Healthcare | |
|
2720 W Division St Chicago IL 60622-2853 | |
| (773) 523-8600 | |
| (773) 687-9545 |
| Full Name | Omni Healthcare |
|---|---|
| Speciality | Internal Medicine |
| Location | 2720 W Division St, Chicago, Illinois |
| Authorized Official Name and Position | Vivek Gupta (PRESIDENT) |
| Authorized Official Contact | 7737727858 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Omni Healthcare Po Box 3603 Oak Brook IL 60522-3603 Ph: (773) 772-7858 | Omni Healthcare 2720 W Division St Chicago IL 60622-2853 Ph: (773) 523-8600 |
| NPI Number | 1033300694 |
|---|---|
| Provider Enumeration Date | 08/07/2007 |
| Last Update Date | 08/29/2023 |
| Certification Date | 08/29/2023 |
| Medicare PECOS PAC ID | 3678668308 |
|---|---|
| Medicare Enrollment ID | O20070926000910 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033300694 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | () | Primary |
| Provider Name | Horia O Stamboliu |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1932155025 PECOS PAC ID: 0941199806 Enrollment ID: I20040311000032 |
| Provider Name | Wayne C Williamson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1699828061 PECOS PAC ID: 3971549544 Enrollment ID: I20050705000897 |
| Provider Name | Vivek Anand Gupta |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1376632976 PECOS PAC ID: 7113925322 Enrollment ID: I20061127000084 |
| Provider Name | Jeffrey a Olson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1952374795 PECOS PAC ID: 7719944156 Enrollment ID: I20080926000634 |
| Provider Name | Dominique V Azarcon |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1780918920 PECOS PAC ID: 4981735149 Enrollment ID: I20100701000718 |
| Provider Name | Eric Mizuno |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1558398388 PECOS PAC ID: 3072639269 Enrollment ID: I20100924000754 |
| Provider Name | Anna a Trotter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700207784 PECOS PAC ID: 2860622990 Enrollment ID: I20140311000555 |
| Provider Name | Anna L Roy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295128098 PECOS PAC ID: 2163740358 Enrollment ID: I20150420001715 |
| Provider Name | Lloyd a Mercado |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457749079 PECOS PAC ID: 9830403559 Enrollment ID: I20150807015178 |
| Provider Name | Janette P Querubin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952704116 PECOS PAC ID: 1759685704 Enrollment ID: I20160211001046 |
| Provider Name | Gaurika Mehra |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1518213537 PECOS PAC ID: 4880980564 Enrollment ID: I20160906002086 |
| Provider Name | Elizabeth Sanchez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457893661 PECOS PAC ID: 2769766351 Enrollment ID: I20170227001674 |
| Provider Name | Cailian Mo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285172643 PECOS PAC ID: 5597040832 Enrollment ID: I20170328002378 |
| Provider Name | Valerie Visitacion Mayuga |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1740697853 PECOS PAC ID: 2163712274 Enrollment ID: I20170627000287 |
| Provider Name | Joseph Olasehinde Olalusi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134633902 PECOS PAC ID: 4486914744 Enrollment ID: I20180205002737 |
| Provider Name | Pamela Flores Pizarro |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225594971 PECOS PAC ID: 4789923640 Enrollment ID: I20190312000567 |
| Provider Name | Sharaine James |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326522459 PECOS PAC ID: 7517297625 Enrollment ID: I20191002001610 |
| Provider Name | Nestor Dante Verano |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679128144 PECOS PAC ID: 1153653191 Enrollment ID: I20191024002086 |
| Provider Name | Ruby Kapoor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922671924 PECOS PAC ID: 5890191704 Enrollment ID: I20210901000556 |
| Provider Name | Jordan T Gitalan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659943785 PECOS PAC ID: 1254721285 Enrollment ID: I20211207001319 |
| Provider Name | Binita Patel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699436113 PECOS PAC ID: 6709278013 Enrollment ID: I20220119000668 |
| Provider Name | Ji Na Khananisho |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437812203 PECOS PAC ID: 4981098076 Enrollment ID: I20220307002256 |
| Provider Name | Queen Nnenna Aghaji |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1518415926 PECOS PAC ID: 4183092950 Enrollment ID: I20221129001321 |
| Provider Name | Tsung-pei Chen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922792563 PECOS PAC ID: 8325408503 Enrollment ID: I20231006002634 |
| Provider Name | Osman Mohamed Aman |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1659954196 PECOS PAC ID: 4082150453 Enrollment ID: I20240722001686 |
| Provider Name | Phillip Michael O'connor |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1659759652 PECOS PAC ID: 7618415613 Enrollment ID: I20240821000575 |
| Provider Name | Jimmy Andrada Orinion |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962234468 PECOS PAC ID: 1456882281 Enrollment ID: I20241004000458 |
| Provider Name | Joseph Wabomnor |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1114782976 PECOS PAC ID: 3375075187 Enrollment ID: I20241017004259 |
| Provider Name | Moneer Miri |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447046842 PECOS PAC ID: 1456859339 Enrollment ID: I20250811000446 |
| Provider Name | Zhuli Sun |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407729189 PECOS PAC ID: 5496245862 Enrollment ID: I20251104004067 |
| Provider Name | Elvira Fe Baquirin Bravo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265391809 PECOS PAC ID: 1658850151 Enrollment ID: I20260205000508 |
| Provider Name | John Velukunnel Pathrose |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497627731 PECOS PAC ID: 1456828961 Enrollment ID: I20260422000687 |
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