Provider Demographics
NPI:1700836632
Name:COLARIC, KENNETH BERNARD (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:BERNARD
Last Name:COLARIC
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 1:900 SO 74 PLZ
Mailing Address - Street 2:STE 108
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-4648
Mailing Address - Country:US
Mailing Address - Phone:402-391-3387
Mailing Address - Fax:402-391-7821
Practice Address - Street 1:7500 MERCY RD
Practice Address - Street 2:ALEGENT HEALTH BERGAN MERCY EMERGENCY DEPT
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124
Practice Address - Country:US
Practice Address - Phone:402-398-6161
Practice Address - Fax:402-398-6982
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE20044207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ038145Medicaid
NE47064207113Medicaid
IA5138503Medicaid
002475OtherRAILROAD MEDICARE - GRP
P00216795OtherRAILROAD MEDICARE
002475OtherRAILROAD MEDICARE - GRP
P00216795OtherRAILROAD MEDICARE