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General NPI Number Information
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NPI Number | 1700836632
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Entity Type | Individual
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Provider Name | KENNETH BERNARD COLARIC MD
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Gender | Male
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Dates
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Enumeration Date | 05/11/2006
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Last Update Date | 08/29/2018
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Provider Practice Location Address
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Address Line | 7500 MERCY RD ALEGENT HEALTH BERGAN MERCY EMERGENCY DEPT
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City | OMAHA
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State | NE
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Zip | 68124
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Country | US
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Telephone | 402-398-6161
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Fax | 402-398-6982
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Provider Business Mailing Address
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Address Line | 900 SO 74 PLZ STE 108
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City | OMAHA
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State | NE
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Zip | 68114-4648
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Country | US
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Telephone | 402-391-3387
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Fax | 402-391-7821
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 20044
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License Number State | NE
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