Individual
MICHAEL L KOEBERNICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
575 S 70TH ST, #400, LINCOLN, NE 68510-2471
(402) 488-3002
(402) 483-8787
Mailing address
2222 S 16TH STREET, MEDICAL TOWER B, #305, LINCOLN, NE 68502
(402) 488-3002
(402) 483-8787
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
937
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
47061995513
—
NE
Enumeration date
12/08/2005
Last updated
12/14/2009
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