Healthcare Provider Details

I. General information

NPI: 1740254259
Provider Name (Legal Business Name): SUSAN A KAMBHU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 07/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4242 FARNAM ST SUITE 590
OMAHA NE
68131-2806
US

IV. Provider business mailing address

4242 FARNAM ST SUITE 590
OMAHA NE
68131-2806
US

V. Phone/Fax

Practice location:
  • Phone: 402-552-9800
  • Fax: 402-552-9898
Mailing address:
  • Phone: 402-552-9800
  • Fax: 402-552-9898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number20832
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number26603
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: