Healthcare Provider Details

I. General information

NPI: 1790849123
Provider Name (Legal Business Name): STEPHEN JAMES HAUDRICH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 N 26TH ST SUITE 104
LINCOLN NE
68521-4746
US

IV. Provider business mailing address

3215 S 31ST ST
LINCOLN NE
68502-5208
US

V. Phone/Fax

Practice location:
  • Phone: 402-465-0010
  • Fax: 402-465-0015
Mailing address:
  • Phone: 402-420-0448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number19347
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: