Healthcare Provider Details

I. General information

NPI: 1760432066
Provider Name (Legal Business Name): SANDEEP MUKHERJEE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 01/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 N 30TH ST STE 5730
OMAHA NE
68131-2128
US

IV. Provider business mailing address

601 N 30TH ST STE 5730
OMAHA NE
68131-2128
US

V. Phone/Fax

Practice location:
  • Phone: 402-449-4692
  • Fax: 402-449-5926
Mailing address:
  • Phone: 402-449-4692
  • Fax: 402-449-5926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number21355
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: