Provider Demographics
NPI:1831126259
Name:DESHMUKH, SONALI S (MD)
Entity Type:Individual
Prefix:
First Name:SONALI
Middle Name:S
Last Name:DESHMUKH
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 1:1111 N 102ND CT STE 200
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-2194
Mailing Address - Country:US
Mailing Address - Phone:402-502-2747
Mailing Address - Fax:402-502-2387
Practice Address - Street 1:1111 N 102ND CT STE 200
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-2194
Practice Address - Country:US
Practice Address - Phone:402-502-2747
Practice Address - Fax:402-502-2387
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE23057207RN0300X
IA33510207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0442731Medicaid
NE47078164513Medicaid
NE04425OtherBC/BS OF NEBRASKA
I07764Medicare UPIN
NE04425OtherBC/BS OF NEBRASKA
NE47078164513Medicaid
NE281778Medicare PIN