Healthcare Provider Details

I. General information

NPI: 1790793255
Provider Name (Legal Business Name): ALBERT KOFI OWUSU-ANSAH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 12/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 S 48TH ST NEONATOLOGY
LINCOLN NE
68506-1283
US

IV. Provider business mailing address

2222 S 16TH ST SUITE 400A
LINCOLN NE
68502-3796
US

V. Phone/Fax

Practice location:
  • Phone: 402-481-7333
  • Fax: 402-481-7579
Mailing address:
  • Phone: 402-483-8590
  • Fax: 402-483-8599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number036-094162
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: