Provider Demographics
NPI:1780767459
Name:MAUSOLF, FREDERICK ARNOLD (MD)
Entity type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:ARNOLD
Last Name:MAUSOLF
Suffix:
Gender:
Credentials:MD
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Mailing Address - Street 1:4645 NORMAL BLVD
Mailing Address - Street 2:SUITE 245
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-5817
Mailing Address - Country:US
Mailing Address - Phone:402-486-4269
Mailing Address - Fax:402-486-1038
Practice Address - Street 1:4645 NORMAL BLVD
Practice Address - Street 2:SUITE 245
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-5817
Practice Address - Country:US
Practice Address - Phone:402-486-4269
Practice Address - Fax:402-486-1038
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2025-05-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE14776207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE280114776Medicaid
NE280114776Medicaid
NE095064Medicare ID - Type Unspecified