Healthcare Provider Details

I. General information

NPI: 1972538296
Provider Name (Legal Business Name): KENT WENDELL KRONBERG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 02/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13808 W MAPLE RD SUITE 100
OMAHA NE
68164-6231
US

IV. Provider business mailing address

13808 W MAPLE RD SUITE 100
OMAHA NE
68164-6231
US

V. Phone/Fax

Practice location:
  • Phone: 402-955-3000
  • Fax: 402-955-7055
Mailing address:
  • Phone: 402-955-3000
  • Fax: 402-955-7055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number16146
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: