Individual
DR. MOHAN R MYSORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8200 DODGE ST, CHILDRENS HOSPITAL - CRITICAL CARE, OMAHA, NE 68114-4113
(402) 955-4226
(402) 955-3262
Mailing address
8200 DODGE ST, CHILDRENS HOSPITAL, OMAHA, NE 68114-4113
(402) 955-5400
Taxonomy
Speciality
Code
Description
License number
State
2080P0203X
Pediatric Critical Care Medicine Physician
Primary
20575
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0909416
—
IA
01
—
32104
BCBS
NE
01
—
8938
MIDLANDS CHOICE
—
Enumeration date
05/10/2006
Last updated
07/08/2007
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