Healthcare Provider Details

I. General information

NPI: 1134709710
Provider Name (Legal Business Name): MEHDI FANAI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2021
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6901 N 72ND ST STE 2400
OMAHA NE
68122-1709
US

IV. Provider business mailing address

6901 N 72ND ST STE 2400
OMAHA NE
68122-1709
US

V. Phone/Fax

Practice location:
  • Phone: 140-271-7007
  • Fax:
Mailing address:
  • Phone: 402-398-6248
  • Fax: 402-829-8513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number37357
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: