Healthcare Provider Details

I. General information

NPI: 1710982913
Provider Name (Legal Business Name): AMEETA B MARTIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMEETA B MARTIN MD

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 09/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 S 70TH ST STE 425
LINCOLN NE
68510-2471
US

IV. Provider business mailing address

2000 Q ST SUITE 500
LINCOLN NE
68503-3610
US

V. Phone/Fax

Practice location:
  • Phone: 402-219-5200
  • Fax: 402-219-5201
Mailing address:
  • Phone: 402-421-0904
  • Fax: 402-421-0946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number18947
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: