# PARK STREET MEDICAL CLINIC PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790086999
- **Authorized official:** MR. BRIAN K. BUHLKE D.O. (OWNER)
- **Authorized official phone:** (402) 993-2206

## Contact information

- **Practice address:** 505 SOUTH PARK STREET, GENOA, NE 68640
- **Practice address phone:** (402) 993-2206
- **Practice address fax:** (402) 993-2595
- **Mailing address:** PO BOX 310, 505 SOUTH PARK STREET, GENOA, NE 68640
- **Mailing address phone:** (402) 993-2206
- **Mailing address fax:** (402) 993-2595

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 11/04/2010
- **Last updated:** 11/04/2010