Healthcare Provider Details

I. General information

NPI: 1972303618
Provider Name (Legal Business Name): MATTHEW DIEM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2025
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

704 S 75TH ST
OMAHA NE
68114-4621
US

IV. Provider business mailing address

704 S 75TH ST
OMAHA NE
68114-4621
US

V. Phone/Fax

Practice location:
  • Phone: 402-556-5290
  • Fax:
Mailing address:
  • Phone: 402-556-5290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: