Provider Demographics
NPI:1376635904
Name:ANDRESEN, JOHN C (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:C
Last Name:ANDRESEN
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:PO BOX 31582
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-0582
Mailing Address - Country:US
Mailing Address - Phone:402-573-7337
Mailing Address - Fax:402-614-2314
Practice Address - Street 1:18018 BURKE STREET
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:NE
Practice Address - Zip Code:68022-4417
Practice Address - Country:US
Practice Address - Phone:402-573-7337
Practice Address - Fax:402-614-2314
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE22078208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE239187OtherMIDLANDS CHOICE
NE10025373200Medicaid
NE994OtherBCBS