Provider Demographics
NPI:1366476822
Name:WHITTLE, THOMAS B (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:B
Last Name:WHITTLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4740 A ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-4822
Mailing Address - Country:US
Mailing Address - Phone:402-483-7825
Mailing Address - Fax:402-483-7839
Practice Address - Street 1:4740 A ST
Practice Address - Street 2:SUITE 100
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-4822
Practice Address - Country:US
Practice Address - Phone:402-483-7825
Practice Address - Fax:402-483-7839
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE225862086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEP00405221OtherRRM
NE240935OtherMIDLANDS CHOICE
NE06387OtherBCBS
IA0727198Medicaid
NE3700142OtherUHC
NE06075OtherBCBS
NE280651Medicare PIN
NE240935OtherMIDLANDS CHOICE