Provider Demographics
NPI:1942379342
Name:MISKE, STEPHANIE A (MD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:A
Last Name:MISKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7601 PIONEERS BLVD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506
Mailing Address - Country:US
Mailing Address - Phone:402-484-6677
Mailing Address - Fax:402-484-4476
Practice Address - Street 1:7601 PIONEERS BLVD
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506
Practice Address - Country:US
Practice Address - Phone:402-484-6677
Practice Address - Fax:402-484-4476
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE184282085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025760000Medicaid
NE47078180813Medicaid
NE47083161300Medicaid
NEP00951203OtherRR MEDICARE - AMI
P00971287OtherRR MEDICARE - SMI
E41670Medicare UPIN
NENA1330021Medicare PIN
NEP00951203OtherRR MEDICARE - AMI
NE47083161300Medicaid
KSP00605849OtherRR MEDICARE
KSK67F394AMedicare PIN
IA3976332Medicaid
NEE41670Medicare UPIN