Healthcare Provider Details

I. General information

NPI: 1295733905
Provider Name (Legal Business Name): MILES C TOMMERAASEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 04/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 S 16TH ST 200
LINCOLN NE
68502-3796
US

IV. Provider business mailing address

2222 S 16TH ST 200
LINCOLN NE
68502-3796
US

V. Phone/Fax

Practice location:
  • Phone: 402-475-9090
  • Fax: 402-475-9092
Mailing address:
  • Phone: 402-475-9090
  • Fax: 402-475-9092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD-13478
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: