Provider Demographics
NPI:1760490981
Name:OHNOUTKA, SUSAN C (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:C
Last Name:OHNOUTKA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:C
Other - Last Name:SCHMIDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5401 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-2150
Mailing Address - Country:US
Mailing Address - Phone:402-413-3531
Mailing Address - Fax:402-413-3535
Practice Address - Street 1:5401 SOUTH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-2150
Practice Address - Country:US
Practice Address - Phone:402-413-3531
Practice Address - Fax:402-413-3535
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE22668207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE096555014OtherMEDICARE
I11823Medicare UPIN
P00154250Medicare PIN
89-02568OtherUHC
NE470780857 23Medicaid
NE243598OtherMIDLAND'S CHOICE
IA0584821Medicaid
P00154250Medicare PIN