Provider Demographics
NPI:1629134929
Name:SJULIN, DAVID H (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:H
Last Name:SJULIN
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 1:555 N 30TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-2136
Mailing Address - Country:US
Mailing Address - Phone:402-280-8100
Mailing Address - Fax:402-280-8103
Practice Address - Street 1:14040 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:BOYS TOWN
Practice Address - State:NE
Practice Address - Zip Code:68010-7521
Practice Address - Country:US
Practice Address - Phone:402-778-6800
Practice Address - Fax:402-778-6874
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE18587207Y00000X, 207YP0228X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric Otolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE00853OtherBCBS ENT
NE1000388Medicaid
NE1000385Medicaid
NE3393OtherMIDLANDS CHOICE
NE1000386Medicaid
NE1000470Medicaid
IA3136978Medicaid
NE1000410Medicaid
NE1000460Medicaid
NE00855OtherBCBS BT
NE1000387Medicaid
NE1000411Medicaid
IA4136978Medicaid
IA5136978Medicaid
NE1000413Medicaid
IA6136978Medicaid
NE3393OtherMIDLANDS CHOICE
IA4136978Medicaid
NE1000387Medicaid