Healthcare Provider Details

I. General information

NPI: 1730289125
Provider Name (Legal Business Name): OMAHA FOOT AND ANKLE SPECIALISTS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 06/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16909 BURKE ST. SUITE 200
OMAHA NE
68118
US

IV. Provider business mailing address

16909 BURKE ST. SUITE 200
OMAHA NE
68118
US

V. Phone/Fax

Practice location:
  • Phone: 402-333-8856
  • Fax: 402-333-3428
Mailing address:
  • Phone: 402-333-8856
  • Fax: 402-333-3428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number220
License Number StateNE

VIII. Authorized Official

Name: MICHAEL P CULLEN
Title or Position: OWNER
Credential: DPM
Phone: 402-333-8856