Provider Demographics
NPI:1760482723
Name:PIECK, JANET S (MD)
Entity Type:Individual
Prefix:DR
First Name:JANET
Middle Name:S
Last Name:PIECK
Suffix:
Gender:F
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:PO BOX 485
Mailing Address - Street 2:
Mailing Address - City:BOYS TOWN
Mailing Address - State:NE
Mailing Address - Zip Code:68010-0485
Mailing Address - Country:US
Mailing Address - Phone:402-727-3580
Mailing Address - Fax:402-727-3618
Practice Address - Street 1:450 E 23RD ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-2303
Practice Address - Country:US
Practice Address - Phone:402-727-3586
Practice Address - Fax:402-727-3618
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE165182085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10-0249668-00Medicaid
NE03322OtherBLUE CROSS BLUE SHIELD
NE03322OtherBLUE CROSS BLUE SHIELD
NE276215Medicare ID - Type Unspecified