=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104109321
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MYPAINDOC, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/23/2011
-----------------------------------------------------
Last Update Date | 05/20/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4307 23RD ST
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68601-8507
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-563-2978
-----------------------------------------------------
Fax | 402-563-2976
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4307 23RD ST
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68601-8507
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-563-2978
-----------------------------------------------------
Fax | 402-563-2976
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR
-----------------------------------------------------
Name | DR. DANIEL M WIK
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 402-563-2978
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP3300X
-----------------------------------------------------
Taxonomy Name | Pain Clinic/Center
-----------------------------------------------------
License Number | 23401
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------