Provider Demographics
NPI:1184649725
Name:CIMINO, JOHN J (MD, FACC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:CIMINO
Suffix:
Gender:M
Credentials:MD, FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12717 S 28TH AVE STE B
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68123-3232
Mailing Address - Country:US
Mailing Address - Phone:402-502-3723
Mailing Address - Fax:
Practice Address - Street 1:12717 S 28TH AVE STE B
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68123-3232
Practice Address - Country:US
Practice Address - Phone:402-502-3723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE18713207RC0000X
IA34442207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA34442OtherSTATE LICENSE
IA0553750Medicaid
NE47083397900Medicaid
NE18713OtherLICENSE #
NE18713OtherLICENSE #
IAI0567Medicare PIN
IA0553750Medicaid