Healthcare Provider Details

I. General information

NPI: 1033201041
Provider Name (Legal Business Name): KENT T HULTQUIST MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 10/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7822 DAVENPORT ST
OMAHA NE
68114-3629
US

IV. Provider business mailing address

7822 DAVENPORT ST
OMAHA NE
68114-3629
US

V. Phone/Fax

Practice location:
  • Phone: 402-391-4855
  • Fax: 402-391-6818
Mailing address:
  • Phone: 402-391-4855
  • Fax: 402-391-6818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number16733
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: