Healthcare Provider Details

I. General information

NPI: 1639285059
Provider Name (Legal Business Name): CHI UKISHIMA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 12/01/2021
Certification Date: 12/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

984455 NEBRASKA MEDICAL CENTER OMAHA NE 68198 4455
OMAHA NE
68198-4455
US

IV. Provider business mailing address

2402 MARILYN DR
PAPILLION NE
68046-4219
US

V. Phone/Fax

Practice location:
  • Phone: 402-559-4081
  • Fax: 402-559-7372
Mailing address:
  • Phone: 402-850-8388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR7899
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: