Provider Demographics
NPI:1629180054
Name:DRABEK, GREGG A (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGG
Middle Name:A
Last Name:DRABEK
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 1:7261 MERCY RD
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-2311
Mailing Address - Country:US
Mailing Address - Phone:402-827-4920
Mailing Address - Fax:402-827-4950
Practice Address - Street 1:16909 LAKESIDE HILLS CT
Practice Address - Street 2:STE 401
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-4664
Practice Address - Country:US
Practice Address - Phone:402-827-4920
Practice Address - Fax:402-827-4950
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD3563208600000X
WY5701A208600000X
NC2007-01041208600000X
NE27597208600000X
IA41422208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA414530095OtherMEDICARE PTAN
NE098684476OtherMEDICARE PTAN
P00415986OtherMEDICARE RAILROAD CARRIER
2072768Medicare PIN
NE098684476OtherMEDICARE PTAN
P00415986OtherMEDICARE RAILROAD CARRIER
NC14642OtherBCBS
SCNC1038Medicaid