Provider Demographics
NPI:1295733020
Name:GREENWALD, HERMAN M (MD)
Entity type:Individual
Prefix:
First Name:HERMAN
Middle Name:M
Last Name:GREENWALD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7261 MERCY RD
Mailing Address - Street 2:NORTH BUILDING, FIRST FLOOR
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-2311
Mailing Address - Country:US
Mailing Address - Phone:402-398-6254
Mailing Address - Fax:402-829-8513
Practice Address - Street 1:7710 MERCY RD
Practice Address - Street 2:SUITE 406
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-2372
Practice Address - Country:US
Practice Address - Phone:402-717-2500
Practice Address - Fax:402-717-2525
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA25343208800000X
NE15990208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA414530091Medicare PIN
NE086248028Medicare PIN
NE098684457Medicare PIN