Provider Demographics
NPI:1881667574
Name:KEIM, LON W (MD)
Entity Type:Individual
Prefix:
First Name:LON
Middle Name:W
Last Name:KEIM
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 1:4242 FARNAM ST
Mailing Address - Street 2:SUITE 355
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-2806
Mailing Address - Country:US
Mailing Address - Phone:402-552-9700
Mailing Address - Fax:
Practice Address - Street 1:4242 FARNAM ST
Practice Address - Street 2:SUITE 355
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131-2806
Practice Address - Country:US
Practice Address - Phone:402-552-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-11
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE13357207RP1001X, 2083P0011X
IA19940207RP1001X, 2083P0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA07633OtherWELLMARK - HAMBURG
NE10025359300Medicaid
NEP00307779OtherRAILROAD MEDICARE
MO200999811Medicaid
IA5902544Medicaid
IA94690OtherWELLMARK - FARNAM
NE00910OtherBCBSN
IA4902544Medicaid
NE10025359300Medicaid
NE00910OtherBCBSN
MOW58A081Medicare ID - Type UnspecifiedINDIVIDUAL
IA5902544Medicaid