Healthcare Provider Details

I. General information

NPI: 1912775164
Provider Name (Legal Business Name): MILAN LASER CORPORATE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2023
Last Update Date: 01/12/2024
Certification Date: 01/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16939 WRIGHT PLZ
OMAHA NE
68130-2091
US

IV. Provider business mailing address

17645 WRIGHT ST
OMAHA NE
68130-2034
US

V. Phone/Fax

Practice location:
  • Phone: 833-667-2967
  • Fax:
Mailing address:
  • Phone: 833-667-2967
  • Fax: 531-233-4494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name: DR. NATHAN HAECKER
Title or Position: CHIEF MEDICAL OFFICER
Credential: MD
Phone: 833-667-2967