Organization
KEVIN P REAGAN MDPC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY DEROUCHEY (PRACTICE MANAGER)
(402) 330-0444
Entity
Organization
Contact information
Practice address
11704 W CENTER RD STE 210, OMAHA, NE 68144-4327
(402) 334-3377
(402) 691-9922
Mailing address
11704 W CENTER RD STE 210, OMAHA, NE 68144-4327
(402) 334-3377
(402) 691-9922
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
16148
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1020800
—
IA
01
—
110219831
TRAVELERS RR MEDICARE
NE
Enumeration date
09/11/2007
Last updated
08/07/2008
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