Healthcare Provider Details

I. General information

NPI: 1528063930
Provider Name (Legal Business Name): JONATHAN MICHAEL LITTLE D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2005
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1413 S WASHINGTON ST STE 270
PAPILLION NE
68046-4193
US

IV. Provider business mailing address

1413 S WASHINGTON ST STE 270
PAPILLION NE
68046-4193
US

V. Phone/Fax

Practice location:
  • Phone: 402-291-3123
  • Fax: 402-291-1560
Mailing address:
  • Phone: 402-291-3123
  • Fax: 402-291-1560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number186
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number186
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: