Healthcare Provider Details

I. General information

NPI: 1609843580
Provider Name (Legal Business Name): MIDLANDS PEDIATRICS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 E GOLD COAST RD SUITE 325
PAPILLION NE
68046-4194
US

IV. Provider business mailing address

401 E GOLD COAST RD SUITE 325
PAPILLION NE
68046-4194
US

V. Phone/Fax

Practice location:
  • Phone: 402-592-1700
  • Fax: 402-592-3335
Mailing address:
  • Phone: 402-592-1700
  • Fax: 402-592-3335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number15261
License Number StateNE

VIII. Authorized Official

Name: DR. AI LAN D KOBAYASHI
Title or Position: PRESIDENT
Credential: MD
Phone: 402-592-1700