Healthcare Provider Details

I. General information

NPI: 1518043744
Provider Name (Legal Business Name): GILES S HEDDERICH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 03/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7440 S 91ST ST
LINCOLN NE
68526-9797
US

IV. Provider business mailing address

7440 S 91ST ST
LINCOLN NE
68526-9797
US

V. Phone/Fax

Practice location:
  • Phone: 402-328-3000
  • Fax:
Mailing address:
  • Phone: 402-328-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number17914
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number17914
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: