MEDICARE: MYPAINDOC, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP3300X	Pain Clinic/Center	23401	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	30304	OTHER		BCBSNE

General Provider Information

NPI Number	:	1104109321
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MYPAINDOC, P.C.

Provider Business Mailing Address
First Line	:	4307 23RD ST
Second Line	:
City	:	COLUMBUS
State	:	NE
Zip	:	68601-8507
Country	:	US
Telephone Number	:	402-563-2978
Fax Number	:	402-563-2976

Provider Business Practice Location Address
First Line	:	4307 23RD ST
Second Line	:
City	:	COLUMBUS
State	:	NE
Zip	:	68601-8507
Country	:	US
Telephone Number	:	402-563-2978
Fax Number	:	402-563-2976

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. DANIEL M WIK
Credential	:	MD
Telephone Number	:	402-563-2978

Provider Enumeration Date	:	09/23/2011
Last Update Date	:	05/20/2025

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Directions to “MYPAINDOC, P.C. ” Practice Location

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