Provider Demographics
NPI:1962469288
Name:CONNOLLY-INDA, EILEEN T (MD)
Entity Type:Individual
Prefix:DR
First Name:EILEEN
Middle Name:T
Last Name:CONNOLLY-INDA
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:988095 NEBRASKA MEDICAL CTR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68198-8095
Mailing Address - Country:US
Mailing Address - Phone:402-559-9800
Mailing Address - Fax:402-559-9840
Practice Address - Street 1:988095 NEBRASKA MEDICAL CTR
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68198-8095
Practice Address - Country:US
Practice Address - Phone:402-559-9800
Practice Address - Fax:402-559-9840
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2013-02-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NE22553207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47078557501Medicaid
NE47078557501Medicaid
NEI02383Medicare UPIN