Healthcare Provider Details

I. General information

NPI: 1457182990
Provider Name (Legal Business Name): MOHAMMAD SAMEER AHMED ZIDAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2024
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7710 MERCY ROAD, SUITE 202 CU DEPT OF FAMILY MEDICINE
OMAHA NE
68124-2353
US

IV. Provider business mailing address

7710 MERCY ROAD, SUITE 202 CU DEPT OF FAMILY MEDICINE
OMAHA NE
68124-2353
US

V. Phone/Fax

Practice location:
  • Phone: 402-280-4318
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number10106
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: