Provider Demographics
NPI:1295012730
Name:JANE B. DAHLKE, M.D., P.C.
Entity Type:Organization
Organization Name:JANE B. DAHLKE, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JANE
Authorized Official - Middle Name:BRUSH
Authorized Official - Last Name:DAHLKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-397-6160
Mailing Address - Street 1:10815 ELM ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-4819
Mailing Address - Country:US
Mailing Address - Phone:402-397-6160
Mailing Address - Fax:402-397-5646
Practice Address - Street 1:10815 ELM ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-4819
Practice Address - Country:US
Practice Address - Phone:402-397-6160
Practice Address - Fax:402-397-5646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-11
Last Update Date:2011-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2084PO800X261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEB67762Medicare UPIN