Provider Demographics
NPI:1922042456
Name:KREMEN, MARK EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:EDWARD
Last Name:KREMEN
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 1:6617 CUMING ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68132-1121
Mailing Address - Country:US
Mailing Address - Phone:402-981-5507
Mailing Address - Fax:402-932-6024
Practice Address - Street 1:10824 OLD MILL RD
Practice Address - Street 2:#21
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-2642
Practice Address - Country:US
Practice Address - Phone:402-330-6060
Practice Address - Fax:402-330-6108
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE216432084P0800X
IA351352084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
275688Medicare ID - Type Unspecified
276220Medicare PIN
NE280189Medicare Oscar/Certification
NE280189Medicare PIN