Provider Demographics
NPI:1083791560
Name:FALLICK, JOHN S (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:S
Last Name:FALLICK
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1101 S 70TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-4278
Mailing Address - Country:US
Mailing Address - Phone:402-483-4292
Mailing Address - Fax:402-483-4735
Practice Address - Street 1:1101 S 70TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-4278
Practice Address - Country:US
Practice Address - Phone:402-483-4292
Practice Address - Fax:402-483-4735
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
NE21129208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery