MEDICARE: ERIK THOR OTTERBERG MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207XS0114X	Adult Reconstructive Orthopaedic Surgery Physician	21337	NE
2	207X00000X	Orthopaedic Surgery Physician	21337	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	09-00253	OTHER	NE	SHARE ADVANTAGE/MERCY RD
2	09-01143	OTHER	NE	SHARE ADVANTAGE/ LAKESIDE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	35110	OTHER	NE	MIDLANDS CHOICE
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	03733	OTHER	NE	BCBS OF NEBRASKA

General Provider Information

NPI Number	:	1831157536
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIK THOR OTTERBERG MD

Provider Business Mailing Address
First Line	:	8005 FARNAM DR STE 305
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68114-3426
Country	:	US
Telephone Number	:	402-390-4111
Fax Number	:	402-390-4115

Provider Business Practice Location Address
First Line	:	8005 FARNAM DR STE 305
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68114-3426
Country	:	US
Telephone Number	:	402-390-4111
Fax Number	:	402-390-4115

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2006
Last Update Date	:	12/15/2023

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Directions to “ ERIK THOR OTTERBERG MD” Practice Location

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