Provider Demographics
NPI:1255334124
Name:FITZKE, GREG A (MD)
Entity type:Individual
Prefix:DR
First Name:GREG
Middle Name:A
Last Name:FITZKE
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 1:1001 S 70TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-7901
Mailing Address - Country:US
Mailing Address - Phone:402-441-4760
Mailing Address - Fax:402-441-4764
Practice Address - Street 1:1001 S 70TH ST STE 100
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510
Practice Address - Country:US
Practice Address - Phone:402-441-4760
Practice Address - Fax:402-441-4764
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE22161208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1714915Medicaid
MO207627203Medicaid
NE30654OtherBCBS - PROMED
P00228457OtherRRM - PROMED
NE1700512OtherUHC - SURGICAL ASSOC
NE236388OtherMIDLANDS - SURGICAL ASSOC
NE1700535OtherSHARE ADV - PROMED
P00331882OtherRRM
NE68510A004OtherWPS/TRIWEST - SURGICAL
KS100424120BMedicaid
NE30348OtherBCBS - SURGICAL ASSOC
IA1714915Medicaid
NE30348OtherBCBS - SURGICAL ASSOC
KS100424120BMedicaid