Healthcare Provider Details

I. General information

NPI: 1144328022
Provider Name (Legal Business Name): PETER D MCLEAY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 10/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8552 CASS ST #308
OMAHA NE
68114-3570
US

IV. Provider business mailing address

8552 CASS ST #308
OMAHA NE
68114-3570
US

V. Phone/Fax

Practice location:
  • Phone: 402-991-5300
  • Fax: 402-991-5407
Mailing address:
  • Phone: 402-991-5300
  • Fax: 402-991-5407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number18014
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number30071
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: