Provider Demographics
NPI:1417192469
Name:J MISKO MD LLC
Entity Type:Organization
Organization Name:J MISKO MD LLC
Other - Org Name:JMISKO SURGICAL DESIGN MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR/MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:MISKO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-484-5144
Mailing Address - Street 1:5800 HIDCOTE DR
Mailing Address - Street 2:STE. 103
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-5536
Mailing Address - Country:US
Mailing Address - Phone:402-499-5938
Mailing Address - Fax:402-484-5145
Practice Address - Street 1:5800 HIDCOTE DR
Practice Address - Street 2:STE. 103
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-5536
Practice Address - Country:US
Practice Address - Phone:402-499-5938
Practice Address - Fax:402-484-5145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-04
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE24755261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty