Provider Demographics
NPI:1245240464
Name:REDLAND, ROALENE J (MD)
Entity Type:Individual
Prefix:
First Name:ROALENE
Middle Name:J
Last Name:REDLAND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17030 LAKESIDE HILLS PLZ STE 127
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-2396
Mailing Address - Country:US
Mailing Address - Phone:402-758-5250
Mailing Address - Fax:402-758-5255
Practice Address - Street 1:17030 LAKESIDE HILLS PLZ STE 127
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-2396
Practice Address - Country:US
Practice Address - Phone:402-758-5250
Practice Address - Fax:402-758-5255
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE17170208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE06181OtherBCBS NEBRASKA
NE7583OtherMIDLANDS CHOICE
IA14968OtherBCBS IOWA
IA1106963Medicaid
NE17-00081OtherSHARE ADVANTAGE/IMMANUEL
NE47076756913Medicaid
NE17-01083OtherSHARE ADVANTAGE/LAKESIDE
NE264919460OtherTRICARE
NE262881Medicare PIN
NE06181OtherBCBS NEBRASKA
NE17-00081OtherSHARE ADVANTAGE/IMMANUEL
IA1106963Medicaid
NEE29184Medicare UPIN