Provider Demographics
NPI:1750698064
Name:SPRINGER, MICHAEL (CCP)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:SPRINGER
Suffix:
Gender:M
Credentials:CCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8625 OAKMONT DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68526-9616
Mailing Address - Country:US
Mailing Address - Phone:402-484-5889
Mailing Address - Fax:402-484-5883
Practice Address - Street 1:8625 OAKMONT DR
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68526-9616
Practice Address - Country:US
Practice Address - Phone:402-484-5889
Practice Address - Fax:402-484-5883
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE16242T00000X
IL214.000192242T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes242T00000XTechnologists, Technicians & Other Technical Service ProvidersPerfusionist