Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 15466 | NE |
NPI | 1063522266 |
---|---|
Provider Name | Jay G Kenik |
First Address | Omaha, NE 68178-0001 |
Second Address | Omaha, NE 68131-2137 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 28/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B67803 | (02) | NE |