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Individual
DR. WAYNE V VIDETICH
Active
Individual
DR. WAYNE V VIDETICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
NE134
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2545
BLUE CROSS/BLUE SHIELD
NE
05
—
47061112100
—
NE
05
—
6800630
—
SD
01
—
NE134
MUTUAL OF OMAHA
NE
Enumeration date
07/16/2006
Last updated
11/16/2007
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