Provider Demographics
NPI:1336142900
Name:WIBBELS, PAUL (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:WIBBELS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2115 N KANSAS AVE
Mailing Address - Street 2:STE 105A
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-2640
Mailing Address - Country:US
Mailing Address - Phone:402-463-2454
Mailing Address - Fax:402-463-2450
Practice Address - Street 1:2115 N KANSAS AVE
Practice Address - Street 2:STE 105A
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-2615
Practice Address - Country:US
Practice Address - Phone:402-463-2454
Practice Address - Fax:402-463-2450
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE19172207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47061219523Medicaid
NEF65999Medicare UPIN
NE267486WIMedicare ID - Type UnspecifiedMEDICARE