Healthcare Provider Details

I. General information

NPI: 1386652964
Provider Name (Legal Business Name): JEFFREY JOHN MUILENBURG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 02/17/2021
Certification Date: 02/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 O ST
AURORA NE
68818-1100
US

IV. Provider business mailing address

609 O ST
AURORA NE
68818-1100
US

V. Phone/Fax

Practice location:
  • Phone: 402-694-3191
  • Fax: 402-694-2146
Mailing address:
  • Phone: 402-694-3191
  • Fax: 402-694-2146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20190
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: