Provider Demographics
NPI:1891139507
Name:FERNANDO E CORREA, M.D., A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:FERNANDO E CORREA, M.D., A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:E
Authorized Official - Last Name:CORREA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-731-9100
Mailing Address - Street 1:4828 S 24TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68107-2703
Mailing Address - Country:US
Mailing Address - Phone:402-731-9100
Mailing Address - Fax:402-731-1297
Practice Address - Street 1:4828 S 24TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68107-2703
Practice Address - Country:US
Practice Address - Phone:402-731-9100
Practice Address - Fax:402-731-1297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-24
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE18632207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========01Medicaid