Healthcare Provider Details

I. General information

NPI: 1487617403
Provider Name (Legal Business Name): KYLE ADAM KREHBIEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 02/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7500 MERCY RD
OMAHA NE
68124-2319
US

IV. Provider business mailing address

PO BOX 4460 RADIOLOGY CONSULTANTS, PC
OMAHA NE
68104
US

V. Phone/Fax

Practice location:
  • Phone: 402-398-6198
  • Fax:
Mailing address:
  • Phone: 866-491-5807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2003-01250
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number24027
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number37408
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: