Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 23281 | NE |
N | 207XS0117X | Orthopaedic Spine Surgeon | 23281 | NE |
NPI | 1104873918 |
---|---|
Provider Name | Dr. James Michael Mahalek |
First Address | Kearney, NE 68845-2909 |
Second Address | Kearney, NE 68845 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2006 |
Last Update Date | 02/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200334990A | (05) | KS |
I05477 | (02) |