Healthcare Provider Details

I. General information

NPI: 1033347521
Provider Name (Legal Business Name): DREW MICHAEL THODESON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2009
Last Update Date: 01/03/2026
Certification Date: 01/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5625 POPPLETON AVE
OMAHA NE
68106-1654
US

IV. Provider business mailing address

5625 POPPLETON AVE
OMAHA NE
68106-1654
US

V. Phone/Fax

Practice location:
  • Phone: 531-495-6000
  • Fax:
Mailing address:
  • Phone: 531-495-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMT195437
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberQ1313
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: