Healthcare Provider Details

I. General information

NPI: 1174699102
Provider Name (Legal Business Name): MICHAEL J DULAC MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13808 WEST MAPLE ROAD CHILDREN'S HOSPITAL - URGENT CARE
OMAHA NE
68164
US

IV. Provider business mailing address

8200 DODGE STREET CHILDREN'S HOSPITAL
OMAHA NE
68114-4113
US

V. Phone/Fax

Practice location:
  • Phone: 402-955-3600
  • Fax: 402-955-7055
Mailing address:
  • Phone: 402-955-5400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number22194
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: