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General NPI Number Information
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NPI Number | 1861885428
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Entity Type | Individual
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Provider Name | JORDAN THOMAS-CASOGLOS BLOUGH MD
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Gender | Male
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Dates
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Enumeration Date | 03/06/2015
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Last Update Date | 09/22/2025
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Provider Practice Location Address
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Address Line | 16901 LAKESIDE HILLS CT
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City | OMAHA
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State | NE
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Zip | 68130-2318
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Country | US
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Telephone | 248-345-9097
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Fax |
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Provider Business Mailing Address
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Address Line | 16901 LAKESIDE HILLS CT
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City | OMAHA
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State | NE
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Zip | 68130-2318
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Country | US
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Telephone | 248-345-9097
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Fax |
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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 | 2086S0105X
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Taxonomy Name | Surgery of the Hand (Surgery) Physician
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License Number | 37135
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | 37135
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License Number State | NE
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