Healthcare Provider Details

I. General information

NPI: 1669471173
Provider Name (Legal Business Name): CARL THOMAS FRANK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16909 LAKESIDE HILLS CT LAKESIDE PROF CRT N STE 200
OMAHA NE
68130-2318
US

IV. Provider business mailing address

16909 LAKESIDE HILLS CT LAKESIDE PROF CRT N STE 200
OMAHA NE
68130-2318
US

V. Phone/Fax

Practice location:
  • Phone: 402-571-5323
  • Fax: 402-571-2495
Mailing address:
  • Phone: 402-571-5323
  • Fax: 402-571-2495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number11319
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number23948
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: