Individual
MILES C TOMMERAASEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2222 S 16TH ST, 200, LINCOLN, NE 68502-3796
(402) 475-9090
(402) 475-9092
Mailing address
2222 S 16TH ST, 200, LINCOLN, NE 68502-3796
(402) 475-9090
(402) 475-9092
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
—
—
208600000X
Surgery Physician
Primary
MD-13478
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020037780
RR MEDICARE
—
01
—
34144
BCBS
NE
05
—
47077266413
—
NE
Enumeration date
07/07/2005
Last updated
04/15/2016
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