Healthcare Provider Details

I. General information

NPI: 1083423420
Provider Name (Legal Business Name): NIKOLAUS MILO KOCOUREK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/31/2024
Last Update Date: 12/31/2024
Certification Date: 12/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 W F ST
HASTINGS NE
68901-6034
US

IV. Provider business mailing address

625 S ROSS AVE
HASTINGS NE
68901-6139
US

V. Phone/Fax

Practice location:
  • Phone: 402-461-3532
  • Fax:
Mailing address:
  • Phone: 402-462-5176
  • Fax: 402-462-5120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: