Healthcare Provider Details

I. General information

NPI: 1194823302
Provider Name (Legal Business Name): CARMELLA N IMIG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 W GRUENTHER RD
GRETNA NE
68028
US

IV. Provider business mailing address

7261 MERCY RD
OMAHA NE
68124-2311
US

V. Phone/Fax

Practice location:
  • Phone: 402-332-2772
  • Fax: 402-332-5446
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20698
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: