Healthcare Provider Details

I. General information

NPI: 1235791641
Provider Name (Legal Business Name): YOSEFUL HAQUE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2019
Last Update Date: 07/11/2024
Certification Date: 04/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8303 DODGE ST
OMAHA NE
68114-4108
US

IV. Provider business mailing address

PO BOX 2797
OMAHA NE
68103-2797
US

V. Phone/Fax

Practice location:
  • Phone: 402-354-4104
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number36409
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: