Provider Demographics
NPI:1982630539
Name:SAFRANEK, THERESE M (MD)
Entity Type:Individual
Prefix:
First Name:THERESE
Middle Name:M
Last Name:SAFRANEK
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 1:503 N 38TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-1801
Mailing Address - Country:US
Mailing Address - Phone:402-556-0040
Mailing Address - Fax:
Practice Address - Street 1:503 N 38TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131-1801
Practice Address - Country:US
Practice Address - Phone:402-556-0040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE16444207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEE46512Medicare UPIN
NE273317Medicare ID - Type Unspecified