Healthcare Provider Details

I. General information

NPI: 1730704701
Provider Name (Legal Business Name): KURTIS C JOHNSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2020
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8303 DODGE ST STE LL6
OMAHA NE
68114-4108
US

IV. Provider business mailing address

8303 DODGE ST STE LL6
OMAHA NE
68114-4108
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 Number9310
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number1730704701
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: