Healthcare Provider Details

I. General information

NPI: 1174634059
Provider Name (Legal Business Name): DIABETES & ENDOCRINE ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 10/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7831 CHICAGO CT
OMAHA NE
68114-3654
US

IV. Provider business mailing address

7831 CHICAGO CT
OMAHA NE
68114-3654
US

V. Phone/Fax

Practice location:
  • Phone: 402-561-2740
  • Fax: 402-561-2738
Mailing address:
  • Phone: 402-561-2740
  • Fax: 402-561-2738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VIII. Authorized Official

Name: CLAIRE BAKER
Title or Position: VICE PRESIDENT
Credential: M.D.
Phone: 402-561-2740