Provider Demographics
NPI:1669471173
Name:FRANK, CARL THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:THOMAS
Last Name:FRANK
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 1:16909 LAKESIDE HILLS CT
Mailing Address - Street 2:LAKESIDE PROF CRT N STE 200
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-2318
Mailing Address - Country:US
Mailing Address - Phone:402-571-5323
Mailing Address - Fax:402-571-2495
Practice Address - Street 1:16909 LAKESIDE HILLS CT
Practice Address - Street 2:LAKESIDE PROF CRT N STE 200
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-2318
Practice Address - Country:US
Practice Address - Phone:402-571-5323
Practice Address - Fax:402-571-2495
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11319174400000X
IA23948174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47073708113Medicaid
NE47073708113Medicaid
NE265586FRMedicare ID - Type Unspecified