Provider Demographics
NPI:1124187984
Name:DEK, MARY C (MD)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:C
Last Name:DEK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARY
Other - Middle Name:C
Other - Last Name:MCGILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:16811 BURKE STREET
Mailing Address - Street 2:STE 101
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68118
Mailing Address - Country:US
Mailing Address - Phone:402-573-7337
Mailing Address - Fax:
Practice Address - Street 1:18018 BURKE STREET
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:NE
Practice Address - Zip Code:68022-4417
Practice Address - Country:US
Practice Address - Phone:402-573-7337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-07
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE21119208000000X
NE21199208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1200591Medicaid
NE1200408Medicaid
NE1201454Medicaid
NE24985OtherMIDLANDS CHOICE
NE34043OtherBCBS OF NEBRASKA
NE1200590Medicaid
NE1200592Medicaid
IA0538579Medicaid
NE1200405Medicaid
IA1538579Medicaid
NE1201173Medicaid