Healthcare Provider Details

I. General information

NPI: 1104930932
Provider Name (Legal Business Name): AGAINDRA K BEWTRA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 07/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 N 30TH ST STE 5730
OMAHA NE
68131-2137
US

IV. Provider business mailing address

2500 CALIFORNIA PLZ
OMAHA NE
68178-0001
US

V. Phone/Fax

Practice location:
  • Phone: 402-280-4403
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number13377
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: