Provider Demographics
NPI:1861666463
Name:CHRUSCICKI, DANIEL ANDREW (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:ANDREW
Last Name:CHRUSCICKI
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:PO BOX 6068
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-0068
Mailing Address - Country:US
Mailing Address - Phone:402-484-9000
Mailing Address - Fax:402-483-4223
Practice Address - Street 1:1710 S 70TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-1676
Practice Address - Country:US
Practice Address - Phone:402-484-9000
Practice Address - Fax:402-483-4223
Is Sole Proprietor?:No
Enumeration Date:2008-04-15
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE24568207WX0107X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEP00870537OtherRAILROAD MEDICARE
KS04-35151OtherMEDICAL LICENSE
NE10025619700Medicaid
NE24568OtherMEDICAL LICENSE
NEP00870537OtherRAILROAD MEDICARE
KSKA1205003Medicare PIN