Provider Demographics
NPI:1831119841
Name:BHOOPALAM, VISHWAJETH B (MD)
Entity Type:Individual
Prefix:
First Name:VISHWAJETH
Middle Name:B
Last Name:BHOOPALAM
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 1:4830 THOMASBROOK LN
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-6702
Mailing Address - Country:US
Mailing Address - Phone:402-450-1995
Mailing Address - Fax:
Practice Address - Street 1:6940 VAN DORN ST STE 201
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506
Practice Address - Country:US
Practice Address - Phone:402-414-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE21757207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAO566638Medicaid
NE47070592313Medicaid
IAO566638Medicaid
G55077Medicare UPIN