Provider Demographics
NPI:1720311095
Name:MAKHDOOM, SAFANA ANNA
Entity Type:Individual
Prefix:DR
First Name:SAFANA
Middle Name:ANNA
Last Name:MAKHDOOM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIVERSITY OF NEBRASKA MEDICAL CTR
Mailing Address - Street 2:DEPT. OF FAMILY MEDICINE 983075 NEBRASKA MEDICAL CENTER
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68198-3075
Mailing Address - Country:US
Mailing Address - Phone:402-559-5641
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF NEBRASKA MEDICAL CTR
Practice Address - Street 2:DEPT. OF FAMILY MEDICINE 983075 NEBRASKA MEDICAL CENTER
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68198-3075
Practice Address - Country:US
Practice Address - Phone:402-559-5641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-17
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE6164207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine