Provider Demographics
NPI:1083720866
Name:HARTWIG, RICKY GENE (MD)
Entity Type:Individual
Prefix:
First Name:RICKY
Middle Name:GENE
Last Name:HARTWIG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 67099
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-7099
Mailing Address - Country:US
Mailing Address - Phone:402-423-7774
Mailing Address - Fax:402-423-7774
Practice Address - Street 1:1730 S 70TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-1613
Practice Address - Country:US
Practice Address - Phone:402-423-7774
Practice Address - Fax:402-423-7774
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE17220207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
277658Medicare ID - Type Unspecified
E28784Medicare UPIN
NE10025092100Medicare ID - Type Unspecified