Healthcare Provider Details

I. General information

NPI: 1861455859
Provider Name (Legal Business Name): JOHN R. KIRCHNER, MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13906 GOLD CIR SUITE 101
OMAHA NE
68144-2336
US

IV. Provider business mailing address

13906 GOLD CIR SUITE 101
OMAHA NE
68144-2336
US

V. Phone/Fax

Practice location:
  • Phone: 402-759-2910
  • Fax: 402-758-2956
Mailing address:
  • Phone: 402-758-2910
  • Fax: 402-758-2956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number10745
License Number StateNE

VIII. Authorized Official

Name: DR. JOHN R KIRCHNER
Title or Position: MD
Credential: MD
Phone: 402-758-2910