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General NPI Number Information
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NPI Number | 1215984695
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Entity Type | Individual
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Provider Name | CONNIE S MICEK M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/30/2006
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Last Update Date | 07/29/2010
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Provider Practice Location Address
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Address Line | 405 W DARLENE ST
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City | HARTINGTON
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State | NE
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Zip | 68739-4806
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Country | US
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Telephone | 402-254-3935
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Fax | 402-254-2393
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Provider Business Mailing Address
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Address Line | PO BOX 937
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City | HARTINGTON
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State | NE
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Zip | 68739-0937
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Country | US
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Telephone | 402-254-3935
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Fax | 402-254-2393
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 20035
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License Number State | NE
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