Provider Demographics
NPI:1508003914
Name:VIVEKANANDAN, RENUGA (MD)
Entity Type:Individual
Prefix:
First Name:RENUGA
Middle Name:
Last Name:VIVEKANANDAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 DOUGLAS ST
Mailing Address - Street 2:503
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68102-1860
Mailing Address - Country:US
Mailing Address - Phone:312-543-9940
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF NEBRASKA
Practice Address - Street 2:982055 NEBRASKA MEDICAL CENTER
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68198-0001
Practice Address - Country:US
Practice Address - Phone:402-559-7792
Practice Address - Fax:402-559-9385
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-08
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE5613207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine