Healthcare Provider Details

I. General information

NPI: 1144277328
Provider Name (Legal Business Name): GROSS, IWERSEN, KRATOCHVIL & KLEIN MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 05/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7710 MERCY RD SUITE 224
OMAHA NE
68124-2372
US

IV. Provider business mailing address

17030 LAKESIDE HILLS PLZ SUITE 200
OMAHA NE
68130-2396
US

V. Phone/Fax

Practice location:
  • Phone: 402-399-8550
  • Fax: 402-399-8455
Mailing address:
  • Phone: 402-399-8550
  • Fax: 402-399-8455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNE

VIII. Authorized Official

Name: TIMOTHY C FITZGIBBONS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 402-399-8550