Healthcare Provider Details

I. General information

NPI: 1427158807
Provider Name (Legal Business Name): MICHAEL S PETTIS MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 01/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7500 MERCY RD
OMAHA NE
68124
US

IV. Provider business mailing address

7710 MERCY RD SUITE 424
OMAHA NE
68124
US

V. Phone/Fax

Practice location:
  • Phone: 402-343-8760
  • Fax: 402-343-8765
Mailing address:
  • Phone: 402-343-8760
  • Fax: 402-343-8765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL PETTIS
Title or Position: PRESIDENT
Credential: MD
Phone: 402-343-8760