Provider Demographics
NPI:1194036723
Name:MACDISSI, ANTHONY JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:JOHN
Last Name:MACDISSI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:16901 LAKESIDE HILLS COURT
Mailing Address - Street 2:ATTN: HOSPITAL MEDICINE DEPT.
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130
Mailing Address - Country:US
Mailing Address - Phone:855-524-4001
Mailing Address - Fax:402-717-7340
Practice Address - Street 1:16901 LAKESIDE HILLS COURT
Practice Address - Street 2:ATTN: HOSPITAL MEDICINE DEPT.
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130
Practice Address - Country:US
Practice Address - Phone:855-524-4001
Practice Address - Fax:402-717-7340
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-29
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE6241207R00000X
IAMD-41698208M00000X
NE26888208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine