Healthcare Provider Details

I. General information

NPI: 1902927221
Provider Name (Legal Business Name): ALEX DWORAK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 12/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44TH AND EMILE UNIVERSITY OF NEBRASKA MED CENTER DEPT FAMILY MEDICINE
OMAHA NE
68102-3075
US

IV. Provider business mailing address

4920 S 30TH ST SUITE 103 LIVESTOCK EXCHANGE BUILDING
OMAHA NE
68107-1590
US

V. Phone/Fax

Practice location:
  • Phone: 402-559-4000
  • Fax: 402-559-8118
Mailing address:
  • Phone: 402-734-4110
  • Fax: 402-734-3990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5389
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: