Healthcare Provider Details

I. General information

NPI: 1639104946
Provider Name (Legal Business Name): KERRY LAINOF MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 02/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 CAPEHART RD STE 1B16
OFFUTT A F B NE
68113-1043
US

IV. Provider business mailing address

510 RIDGE RD
BELLEVUE NE
68005-2547
US

V. Phone/Fax

Practice location:
  • Phone: 402-294-6077
  • Fax:
Mailing address:
  • Phone: 402-293-0321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number19050
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: