Healthcare Provider Details

I. General information

NPI: 1053674051
Provider Name (Legal Business Name): CHAKRI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2012
Last Update Date: 06/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11766 WHITMORE ST
OMAHA NE
68142-1639
US

IV. Provider business mailing address

11711 ARBOR ST SUITE 240
OMAHA NE
68144-2979
US

V. Phone/Fax

Practice location:
  • Phone: 712-328-5490
  • Fax:
Mailing address:
  • Phone: 402-393-9459
  • Fax: 402-397-1977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: TIFFINY KASZUBA
Title or Position: BILLING MANAGER
Credential:
Phone: 402-397-5466