Provider Demographics
NPI:1518043744
Name:HEDDERICH, GILES S (MD)
Entity Type:Individual
Prefix:
First Name:GILES
Middle Name:S
Last Name:HEDDERICH
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 1:7440 S 91ST ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68526-9797
Mailing Address - Country:US
Mailing Address - Phone:402-328-3000
Mailing Address - Fax:
Practice Address - Street 1:7440 S 91ST ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68526-9797
Practice Address - Country:US
Practice Address - Phone:402-328-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE17914208G00000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47070592302Medicaid
NE47070592305Medicaid
IA0537142Medicaid
NE47070592301Medicaid
NE47070592306Medicaid
KS100126310BMedicaid
NE47070592300Medicaid
NE47070592313Medicaid
KS100126310BMedicaid
IA0537142Medicaid
E28783Medicare UPIN
NE47070592301Medicaid
NE47070592302Medicaid