Healthcare Provider Details

I. General information

NPI: 1124079819
Provider Name (Legal Business Name): EDMUND O FIKSINSKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 11/03/2022
Certification Date: 11/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 N 103RD PLZ SUITE 100
OMAHA NE
68114-1114
US

IV. Provider business mailing address

PO BOX 3755
OMAHA NE
68103-0755
US

V. Phone/Fax

Practice location:
  • Phone: 402-391-5055
  • Fax: 402-384-4202
Mailing address:
  • Phone: 402-354-2100
  • Fax: 402-354-6171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number24213
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number24213
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: