Provider Demographics
NPI:1730289125
Name:OMAHA FOOT AND ANKLE SPECIALISTS PC
Entity Type:Organization
Organization Name:OMAHA FOOT AND ANKLE SPECIALISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:CULLEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:402-333-8856
Mailing Address - Street 1:16909 BURKE ST.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68118
Mailing Address - Country:US
Mailing Address - Phone:402-333-8856
Mailing Address - Fax:402-333-3428
Practice Address - Street 1:16909 BURKE ST.
Practice Address - Street 2:SUITE 200
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68118
Practice Address - Country:US
Practice Address - Phone:402-333-8856
Practice Address - Fax:402-333-3428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE220213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEDA4693OtherMEDICARE RR
NE=========07Medicaid
NE099390Medicare PIN
NEDA4693OtherMEDICARE RR