Provider Demographics
NPI:1780618272
Name:JOBST, MICHAEL A (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:JOBST
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:2006-07-10
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE21606208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47059807113Medicaid
KS200573880AMedicaid
NE04010OtherBCBS NE
NE04010OtherBCBS NE
NEI31145Medicare UPIN
NE47059807113Medicaid
NE098104002Medicare PIN