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General NPI Number Information
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NPI Number | 1376589465
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Entity Type | Individual
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Provider Name | MICHAEL DEAN SOE MD
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Gender | Male
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Dates
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Enumeration Date | 06/20/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 450 EAST 23RD ST
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City | FREMONT
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State | NE
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Zip | 68025
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Country | US
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Telephone | 402-721-3070
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Fax | 402-727-3513
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Provider Business Mailing Address
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Address Line | 415 E 23RD ST STE 210
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City | FREMONT
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State | NE
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Zip | 68025-2393
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Country | US
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Telephone | 402-721-4866
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Fax | 402-721-3229
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 18553
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License Number State | NE
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