Provider Demographics
NPI:1881639573
Name:KRESHEL, CHARLES L (MD)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:L
Last Name:KRESHEL
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 1:1021 N 27TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68503-1803
Mailing Address - Country:US
Mailing Address - Phone:402-476-1455
Mailing Address - Fax:402-476-1670
Practice Address - Street 1:3100 N 14TH ST STE 201
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68521-2134
Practice Address - Country:US
Practice Address - Phone:402-477-6600
Practice Address - Fax:402-476-1670
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-18
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE16450207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47074554413Medicaid
NE089935Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID
NE47074554413Medicaid