Individual
HENRY JOHN DETHLEFS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4920 S 30TH ST, SUITE 103, OMAHA, NE 68107-1590
(402) 734-4110
(402) 991-5564
Mailing address
4920 S 30TH ST, SUITE 103, OMAHA, NE 68107-1590
(402) 734-4110
(402) 991-5564
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
19813
NE
Other
Enumeration date
07/09/2006
Last updated
07/08/2007
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